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A 
PSYCHIATRIC  MILESTONE 

BLOOMINGDALE    HOSPITAL 
CENTENARY 

1821-1921 


"  Cum  corpore  ut  una 

Crescere  sentimus,  pariterque  senescere  mentem." 

— LUCRETIUS 


PRIVATELY  PRINTED 

BY  THE  SOCIETY  OF  THE  NEW  YORK  HOSPITAL 
1921 


. 

m 


ANNIVERSARY    COMMITTEE 

HOWARD  TOWNSEND 
BRONSON  WINTHROP 
R.  HORACE  GALLATIN 


PREFACE 

The  opening  of  Bloomingdale  Asylum  on  June  i, 
1821,  was  an  important  event  in  the  treatment  of 
mental  disorders  and  in  the  progress  of  humanitarian 
and  scientific  work  in  America.  Hospital  treatment 
for  persons  suffering  from  mental  disorders  had  been 
furnished  by  the  New  York  Hospital  since  its  open- 
ing in  1792,  and  the  Governors  had  given  much 
thought  and  effort  to  securing  the  facilities  needed. 
The  treatment  consisted,  however,  principally  in  the 
administration  of  drugs  and  the  employment  of  such 
other  physical  measures  as  were  in  vogue  at  that 
time.  Little  attempt  was  made  to  study  the  minds 
of  the  patients  or  to  treat  them  by  measures  di- 
rected specifically  to  influencing  their  thoughts,  feel- 
ings, and  behavior,  and  what  treatment  of  this 
character  there  was  had  for  its  object  little  more 
than  the  repression  of  excitement  and  disordered 
activity.  The  value  and  importance  of  treatment 
directed  to  the  mind  had,  indeed,  been  long  recog- 
nized, but  in  practice  it  had  been  subordinated  to 
treatment  of  the  actual  and  assumed  physical  dis- 
orders to  which  the  mental  state  of  the  patient  was 
attributed,  and,  in  the  few  hospitals  where  persons 

[vii] 


PREFACE 

suffering  from  mental  disorders  were  received,  means 
for  its  application  were  almost  or  quite  entirely 
lacking.  The  establishment  of  Bloomingdale  Asy- 
lum for  the  purpose  of  ascertaining  to  what  extent 
the  recovery  of  the  patients  might  be  accomplished 
by  moral  as  well  as  by  purely  medical  treatment 
marked,  therefore,  the  very  earliest  stages  of  the 
development  in  America  of  the  system  of  study  and 
treatment  of  mental  disorders  which  with  increasing 
amplification  and  precision  is  now  universally  em- 
ployed. 

A  hundred  years  of  growth  and  activity  in  the  work 
thus  established  have  now  been  accomplished,  and 
it  seemed  fitting  to  the  Governors  of  the  Hospital 
that  the  event  should  be  commemorated  in  a  way 
that  would  be  appropriate  to  its  significance  and  im- 
portance. It  was  decided  that  the  principal  place  in 
the  celebration  should  be  given  to  the  purely  medical 
and  scientific  aspects  of  the  work,  with  special  refer- 
ence to  the  progress  which  had  been  made  in  the 
direction  of  the  practical  usefulness  of  psychiatry 
in  the  treatment  of  illness  generally,  and  in  the  man- 
agement of  problems  of  human  behavior  and  wel- 
fare. Arrangements  were  made  for  four  addresses 
by  physicians  of  conspicuous  eminence  in  their  par- 
ticular fields,  and  invitations  to  attend  the  exercises 
were  sent  to  the  leading  psychiatrists,  psychologists, 

[  viii  ] 


PREFACE 

and  neurologists  of  America,  and  to  others  who  were 
known  to  be  specially  interested  in  the  field  of  study 
and  practice  in  which  the  Hospital  is  engaged.  It 
was  felt  that,  in  view  of  the  place  which  France  and 
England  had  held  in  the  movement  in  which  Bloom- 
ingdale  Asylum  had  its  origin,  it  would  add  greatly 
to  the  interest  and  value  of  the  celebration  if  repre- 
sentatives of  these  countries  were  present  and  made 
addresses.  How  fortunate  it  was,  then,  that  it  be- 
came possible  to  welcome  from  France  Dr.  Pierre 
Janet,  who  stands  pre-eminent  in  the  field  of  psy- 
chopathology,  and  from  England  Dr.  Richard  G. 
Rows,  whose  contributions  to  the  study  and  treat- 
ment of  the  war  neuroses  and  to  the  relation  between 
psychic  and  physical  reactions  marked  him  as  espe- 
cially qualified  to  present  the  more  advanced  view- 
point of  British  psychiatry.  The  other  two  princi- 
pal addresses  were  made  by  Dr.  Adolf  Meyer,  who, 
by  reason  of  his  scientific  contributions  and  his  won- 
derfully productive  practical  work  in  clinical  and 
organized  psychiatry  and  in  mental  hygiene,  is  the 
acknowledged  leader  of  psychiatry  in  America,  and 
by  Dr.  Lewellys  F.  Barker,  who,  because  of  his  emi- 
nence as  an  internist  and  of  the  extent  to  which 
he  has  advocated  and  employed  psychiatric  knowl- 
edge and  methods  in  his  practice,  has  contributed 
greatly  to  interesting  and  informing  physicians  con- 

[ix] 


PREFACE 

cerning  the  value  and  importance  of  psychiatry  in 
general  medical  practice.  The  addresses  given  by 
these  distinguished  physicians,  representing  advanced 
views  in  psychiatry  held  in  Europe  and  America, 
were  peculiarly  appropriate  to  the  occasion  and  to 
the  object  of  the  celebration.  They  were  supple- 
mented by  an  historical  review  of  the  origin  and 
development  of  the  Hospital  and  of  its  work  by  Mr. 
Edward  W.  Sheldon,  President  of  the  Society  of  the 
New  York  Hospital,  and  by  a  statement  concern- 
ing the  medical  development,  made  by  Dr.  William 
L.  Russell,  the  Medical  Superintendent.  The  greet- 
ings of  the  New  York  Academy  of  Medicine  were 
presented  in  an  interesting  address  by  Dr.  George  D. 
Stewart,  President  of  the  Academy. 

Of  scarcely  less  significance  and  interest  than  the 
addresses  was  the  pageant  presented  on  the  lawn 
during  the  intermission  between  the  sessions,  de- 
picting scenes  and  incidents  illustrating  the  origin 
and  development  of  the  Hospital,  and  of  psychiatry 
and  mental  hygiene.  The  text  and  the  scenes  dis- 
played were  prepared  by  Dr.  Charles  I.  Lambert, 
First  Assistant  Physician  of  the  Hospital,  and  by 
Mrs.  Adelyn  Wesley,  who  directed  the  performance 
and  acted  as  narrator.  The  performers  were  per- 
sons who  were  connected  with  the  Hospital,  twenty- 
two  of  whom  were  patients. 


PREFACE 

The  celebration  was  held  on  May  26,  1921.  The 
weather  was  exceptionally  clear,  with  bright  sunshine 
and  moderate  temperature.  The  grounds,  in  their 
Spring  dress  of  fresh  leaves  and  flowers,  were  espe- 
cially beautiful.  This  added  much  to  the  attrac- 
tiveness of  the  occasion  and  the  pleasure  of  those  who 
attended.  Luncheon  was  served  on  the  lawn  in 
front  of  the  Brown  Villa  and  the  pageant  was  pre- 
sented on  the  adjoining  recreation  grounds.  The 
beauty  of  the  day  and  the  surroundings,  the  character 
of  the  addresses  and  of  the  speakers,  the  remarkable 
felicity  and  grace  with  which  they  were  introduced 
by  the  President,  the  dignity  and  noble  idealism  of 
his  closing  words,  and  the  distinguished  character 
of  the  audience,  all  contributed  to  make  the  celebra- 
tion one  of  exceptional  interest  and  value  to  those 
who  were  present,  and  a  notable  event  in  the  history 
of  the  Hospital. 

For  the  purpose  of  preserving,  and  of  perhaps 
extending  to  some  who  were  not  present,  the  spirit 
of  the  occasion,  and  of  placing  in  permanent  form  an 
account  of  the  proceedings  and  the  addresses  which 
were  made,  this  volume  has  been  published  by  the 
Society  of  the  New  York  Hospital. 

WILLIAM  L.  RUSSELL. 


[xi] 


CONTENTS 


PAGE 


PREFACE vii 

INVOCATION 3 

REV.  FRANK  H.  SIMMONDS 


HISTORICAL  REVIEW 


EDWARD   W.    SHELDON,    ESQ. 

President  of  the  Society  of  the  New  York  Hospital 

"THE  CONTRIBUTIONS  OF  PSYCHIATRY  TO  THE  UNDER- 
STANDING OF  LIFE  PROBLEMS" 17 

ADOLF  MEYER,  M.D. 

Director  of  the  Henry  Phipps  Psychiatric  Clinic,  Johns  Hop- 
kins Hospital,  and  Professor  of  Psychiatry,  Johns  Hopkins 
University,  Baltimore,  Maryland 

"THE  IMPORTANCE  OF  PSYCHIATRY  IN  GENERAL  MEDICAL 

PRACTICE" 55 

LEWELLYS  F.  BARKER,  M.D. 

Professor  of  Clinical  Medicine,  Johns  Hopkins  Medical  School, 
Baltimore,  Maryland 

GREETINGS  FROM  THE  NEW  YORK  ACADEMY  OF  MEDI- 
CINE   79 

GEORGE  D.  STEWART,  M.D. 

President  of  the  Academy 


CONTENTS 

PAGE 

"THE  BIOLOGICAL  SIGNIFICANCE  OF  MENTAL  ILLNESS"  .       89 

RICHARD    G.    ROWS,   M.D. 

Director  of  the  Section  on  Mental  Illnesses  of  the  Special 
Neurological  Hospital,  Tooting,  London,  England 

"THE  RELATION  OF  THE  NEUROSES  TO  THE  PSYCHOSES"     115 
PIERRE  JANET,  M.D. 

Professor  of  Psychology,  College  de  France 

"THE  MEDICAL  DEVELOPMENT  OF  BLOOMINGDALE  HOS- 
PITAL"   ...........'..     147 

WILLIAM  L.  RUSSELL,  M.D. 

Medical  Superintendent 

THE  TABLEAU-PAGEANT 171 

NAMES  OF  THOSE  WHO  ATTENDED  THE  EXERCISES    .      .     177 
APPENDIX  I 191 

COMMUNICATIONS    FROM   DR.    BEDFORD    PIERCE 

Medical  Superintendent  of  The  Retreat,  York,  England 

EXTRACT  FROM  MINUTES  OF  BOARD  OF  DIRECTORS  OF 
THE  RETREAT,  APRIL  30,  192!. 

TRANSCRIPT  FROM  THE  VISITORS  BOOK  OF  THE  RE- 
TREAT, 1803-17. 

APPENDIX  II 195 

A  LETTER  ON  PAUPER  LUNATIC  ASYLUMS  FROM  SAMUEL 
TUKE  TO  THOMAS  EDDY,  1815. 

APPENDIX  III 200 

THOMAS  EDDY'S  COMMUNICATION  TO  THE  BOARD  OF 
GOVERNORS,  APRIL,  1815. 

APPENDIX  IV 209 

EXTRACTS  FROM  THE  MINUTES  OF  THE  BOARD  OF  GOV- 
ERNORS IN  RELATION  TO  ACTION  TAKEN  RESPECTING 
THOS.  EDDY'S  COMMUNICATION  DATED  APRIL,  1815. 

[xiv] 


CONTENTS 

PAGE 

APPENDIX  V 212 

ADDRESS  TO  THE   PUBLIC  BY  THE  GOVERNORS,    l82I. 

APPENDIX  VI 216 

BOARD  OF  GOVERNORS  OF  THE  SOCIETY  OF  THE  NEW 
YORK  HOSPITAL,  l82I  AND  192!. 

APPENDIX  VII 218 

ORGANIZATION  OF  BLOOMINGDALE  HOSPITAL,  l82I  AND 
1921. 


[rv] 


ILLUSTRATIONS 

New  York  Hospital  and  Lunatic  Asylum,  1808       .  Frontispiece 

FACING   PAGE 

Bloomingdale  Asylum,  1821 2 

Bloomingdale  Asylum,  1894 80 

Bloomingdale  Hospital,  1921        148 

The  Tableau-Pageant 172 

Thomas  Eddy 195 


THE    SOCIETY    OF 
THE    NEW    YORK    HOSPITAL 


BLOOMINGDALE  HOSPITAL  CENTENARY 

The  One  Hundredth  Anniversary  of  the  estab- 
lishment of  Bloomingdale  Hospital  as  a  separate 
department  for  mental  diseases  of  The  Society  of 
the  New  York  Hospital  was  celebrated  at  the  Hos- 
pital at  White  Plains  on  Thursday,  May  26,  1921. 
The  addresses  were  given  in  the  Assembly  Hall. 

Mr.  Edward  W.  Sheldon,  the  President  of  the 
Society,  acted  as  Chairman. 

MORNING  SESSION 

The  exercises  opened  with  an  invocation  by  the 
Reverend  Frank  H.  Simmonds,  rector  of  Grace 
Episcopal  Church  at  White  Plains: 

Oh,  most  mighty  and  all-merciful  God,  whose 
power  is  over  all  Thy  works,  who  wiliest  that  all 
men  shall  glorify  Thee  in  the  constant  bringing  to 
perfection  those  powers  of  Thine  which  shall  more 
and  more  make  perfect  the  beings  of  Thy  creation, 
we  glorify  Thee  in  the  gift  of  Thy  Divine  Son  Jesus 
Christ,  the  Great  Physician  of  our  souls,  the  Sun  of 
Righteousness  arising  with  healing  in  His  wings,  who 
disposeth  every  great  and  little  incident  to  the  glory 
of  God  the  Father,  and  to  the  comfort  of  them  that 

[3] 


A    PSYCHIATRIC   MILESTONE 

love  and  serve  him,  we  render  thanks  to  Thee  and 
glorify  Thy  Name,  this  day,  which  brings  to  com- 
pletion the  hundredth  anniversary  of  this  noble  in- 
stitution's birthday.  Oh,  Thou,  who  didst  put  it  into 
the  hearts  and  minds  of  men  to  dedicate  their  lives 
and  fortunes  to  the  advancement  of  science  and 
medicine  for  the  sick  and  afflicted,  we  render  Thee 
most  high  praise  and  hearty  thanks  for  the  grace 
and  virtue  of  the  founders  of  this  institution — men 
whose  names  are  written  in  the  Golden  Book  of  life 
as  those  who  loved  their  fellow  men. 

We  praise  Thee  for  such  men  as  Thomas  Eddy, 
James  Macdonald,  Pliny  Earle,  and  these  endless 
others,  who  from  age  to  age  have  held  high  the  torch 
of  knowledge  and  have  kept  before  them  the  golden 
rule  of  service.  Inasmuch  as  ye  have  done  it  unto 
one  of  the  least  of  these  my  brethren,  ye  have  done 
it  unto  me. 

Be  pleased,  oh  merciful  Father,  to  bless  this  day 
and  gathering.  Lift  up  and  enlighten  our  hearts 
and  minds  to  a  higher  perception  of  all  that  is  noble, 
all  that  is  true,  all  that  is  merciful.  Awaken  our 
dull  senses  to  the  full  knowledge  of  light  in  Thee, 
and  may  all  that  is  said  and  done  be  with  the  guid- 
ing of  Thy  Holy  Spirit. 

We  pray  for  the  continued  blessing  of  this  institu- 
tion and  hospital,  and  on  all  those  who  are  striving 


THE    CENTENARY 

to  bring  out  of  darkness  those  unhappy  souls,  into 
the  pure  light  of  understanding. 

Bless  the  Governors,  physicians,  and  nurses,  di- 
rect their  judgments,  prosper  their  undertakings, 
and  dispose  their  ministry  that  the  world  may  feel 
the  blessing  and  comfort  of  life  in  the  prevention  of 
disease  and  the  preservation  of  health.  And  may 
we  all  be  gathered  in  this  nation  to  a  more  perfect 
unity  of  life  and  purpose  in  the  desire  to  spend  and 
be  spent  in  the  service  of  our  fellow  men. 

We  ask  it  all  in  the  name  and  through  the  media- 
tion of  Thy  Son  Jesus  Christ,  our  Lord.  Amen. 


[5] 


ADDRESS       BY 

MR.    EDWARD    W.     SHELDON 


MR.  SHELDON 

It  is  with  profound  gratification  that  the  Gover- 
nors welcome  your  generous  presence  to-day  on  an 
occasion  which  means  so  much  to  us  and  which  has 
perhaps  some  general  significance.  For  we  are  met 
in  honor  of  what  is  almost  a  unique  event  in  our 
national  history,  the  centennial  anniversary  cele- 
bration of  an  exclusively  psychopathic  hospital.  A 
summary  of  its  origin  and  development  may  be 
appropriate. 

A  hundred  and  fifty  years  ago  the  only  institu- 
tions on  this  side  of  the  Atlantic  which  cared  for 
mental  diseases  were  the  Pennsylvania  Hospital, 
chartered  in  1751,  a  private  general  hospital  which 
had  accommodations  for  a  few  mental  cases,  and 
the  Eastern  State  Hospital  for  the  insane,  at  Wil- 
liamsburg,  Virginia,  a  public  institution  incorporated 
in  1768.  No  other  one  of  the  thirteen  Colonies  had 
a  hospital  of  any  kind,  general  or  special.  With  a 
view  of  remedying  this  deplorable  lack  in  New  York, 
steps  were  taken  in  1769  to  establish  an  adequate 
general  hospital  in  the  City  of  New  York.  This  re- 
sulted in  the  grant,  on  June  n,  1771,  of  the  Royal 
Charter  of  The  Society  of  the  New  York  Hospital. 


A    PSYCHIATRIC    MILESTONE 

Soon  afterward  the  construction  of  the  Hospital 
buildings  began  on  a  spacious  tract  on  lower  Broad- 
way opposite  Pearl  Street,  in  which  provision  was 
also  to  be  made  for  mental  cases;  but  before  any 
patients  could  be  admitted,  an  accidental  fire,  in 
February,  1775,  consumed  the  interior  of  the  build- 
ings. Reconstruction  was  immediately  undertaken 
and  completed  early  in  the  spring  of  1776.  But  by 
that  time  the  Revolutionary  War  was  in  full  course, 
and  the  buildings  were  taken  over  by  the  Continental 
authorities  as  barracks  for  troops,  and  were  sur- 
rounded by  fortifications.  When  the  British  cap- 
tured the  city  in  September,  1776,  they  made  the 
same  use  of  the  buildings  for  their  own  troops,  who 
remained  there  until  1783.  A  long  period  of  read- 
justment then  ensued,  and  it  was  not  until  January, 
1791,  that  the  Hospital  was  at  last  opened  to  patients. 
In  September,  1792,  the  Governors  directed  the  ad- 
mission of  the  first  mental  case,  and  for  the  hundred 
and  twenty-nine  years  since  that  time  the  Society 
has  continuously  devoted  a  part  of  its  effort  to  the 
care  of  the  mentally  diseased.  After  a  few  years  a 
separate  building  for  them  was  deemed  desirable, 
and  was  constructed.  The  State  assisted  this  expan- 
sion of  the  Hospital  by  appropriating  to  the  Society 
$12,500  a  year  for  fifty  years.  This  new  building 
housed  comfortably  seventy-five  patients,  but  ten 

[10] 


HISTORICAL    REVIEW 

years  later  even  this  proved  inadequate  in  size  and 
undesirable  in  surroundings.  In  the  meanwhile  a 
wave  of  reform  in  the  care  of  the  insane  was  rising 
in  Europe  under  the  influence  of  such  benefactors  as 
Philippe  Pinel  in  France,  and  William  and  Samuel 
Tuke  in  England.  Thomas  Eddy,  a  philanthropic 
Quaker  Governor  of  the  Society,  who  was  then  its 
Treasurer  and  afterward  in  succession  its  Vice- 
President  and  President,  becoming  aware  of  this 
movement,  and  having  made  a  special  study  of  the 
care  and  cure  of  mental  affections,  presented  a  com- 
munication to  the  Governors  in  which  he  advocated 
a  change  in  the  medical  treatment,  and  in  particular 
the  adoption  of  the  so-called  moral  management 
similar  to  that  pursued  by  the  Tukes  at  The  Retreat, 
in  Yorkshire,  England.  This  memorable  communi- 
cation was  printed  by  the  Governors,  and  consti- 
tutes one  of  the  first  of  the  systematic  attempts 
made  in  the  United  States  to  put  this  important 
medical  subject  on  a  humane  and  scientific  basis. 
To  carry  out  his  plan,  Mr.  Eddy  urged  the  purchase 
of  a  large  tract  of  land  near  the  city  and  the  'erection 
of  suitable  buildings.  He  ventured  the  moderate 
estimate  that  the  population  of  the  city,  then  about 
110,000,  might  be  doubled  by  1836,  and  quadrupled 
by  1856.  In  fact,  it  was  more  than  doubled  in  those 
first  twenty  years,  and  sextupled  in  the  second 


A    PSYCHIATRIC   MILESTONE 

twenty.  He  was  justified,  therefore,  in  believing 
that  the  hospital  site  on  lower  Broadway  would 
soon  be  surrounded  by  a  dense  population,  and  quite 
unsuited  for  the  efficient  care  of  mental  diseases. 
The  Governors  gave  these  recommendations  im- 
mediate and  favorable  consideration.  Various  tracts 
of  land,  containing  in  all  about  seventy-seven  acres, 
and  lying  on  the  historic  Harlem  Heights  between 
what  are  now  Riverside  Drive  and  Columbus  Avenue, 
and  ic>7th  and  i2Oth  Streets,  were  subsequently 
bought  by  the  Society  for  about  $31,000.  To  aid 
in  the  construction  and  maintenance  of  the  neces- 
sary hospital  buildings,  the  Legislature,  by  an  act 
reciting  that  there  was  no  other  institution  in  the 
State  where  insane  patients  could  be  accommodated, 
and  that  humanity  and  the  interest  of  the  State  re- 
quired that  provision  should  be  made  for  their  care 
and  cure,  granted  an  additional  annual  appropria- 
tion of  $10,000  to  the  Society  from  1816  until  1857. 
The  main  Hospital,  built  of  brownstone,  stood  where 
the  massive  library  of  Columbia  University  now  is, 
and  the  brick  building  still  standing  at  the  north- 
east corner  of  Broadway  and  n6th  Street  was  the 
residence  of  the  Medical  Superintendent.  The  only 
access  to  this  site  by  land  was  over  what  was  known 
as  the  Bloomingdale  Road,  running  from  Broadway 
and  23d  Street  through  the  Bloomingdale  district 

[12] 


HISTORICAL    REVIEW 

on  the  North  River  to  n6th  Street,  and  from  that 
fact  our  institution  assumed  the  name  of  Blooming- 
dale  Asylum,  or,  as  it  is  now  called,  Bloomingdale 
Hospital.  This  beautiful  elevated  site  overlooking 
the  Hudson  River  and  the  Harlem  River  was  admi- 
rably fitted  for  its  purpose.  The  spacious  tract  of 
land,  laid  out  in  walks  and  gardens,  an  extensive 
grove  of  trees,  generous  playgrounds  and  ample 
greenhouses,  combined  to  give  the  spot  unusual 
beauty  and  efficiency.  This  notable  work  finished, 
the  Governors  of  the  Society  issued  on  May  10, 
1821,  an  "Address  to  the  Public"*  which  marks  so 
great  an  advance  in  psychiatry  in  our  country  that 
it  deserves  study.  The  national  character  of  the 
institution  was  indicated  in  the  opening  paragraph, 
where  it  announced  that  the  Asylum  would  be  open 
for  the  reception  of  patients  from  any  part  of  the 
United  States  on  the  first  of  the  following  June. 
Accommodation  for  200  patients  was  provided,  and 
to  these  new  surroundings  were  removed  on  that  day 
all  the  mental  cases  then  under  treatment  at  the  New 
York  Hospital  on  lower  Broadway. 

In  this  retired  and  ideal  spot  the  work  of  Bloom- 
ingdale Hospital  was  successfully  prosecuted  for 

*  Address  of  the  Governors  of  the  New  York  Hospital,  to  the 
Public,  relative  to  the  Asylum  for  the  Insane  at  Bloomingdale,  New 
York,  May  loth,  1821.  Reprinted  by  Bloomingdale  Hospital  Press, 
White  Plains,  May  26,  1921.  See  Appendix  V,  p.  212. 

[13] 


A    PSYCHIATRIC    MILESTONE 

three-quarters  of  a  century.  But  the  seven  miles 
that  separated  it  from  the  old  hospital  was  steadily 
built  over,  and  before  fifty  years  had  gone  the  growth 
of  the  city  had  passed  the  asylum  grounds.  Fore- 
seeing that  they  could  not  maintain  that  verdant 
oasis  intact  for  many  years  longer,  the  Governors, 
in  1868,  bought  this  3<DO-acre  tract  on  the  outskirts 
of  the  Village  of  White  Plains.  After  prolonged 
consideration  of  the  time  and  method  of  develop- 
ment of  the  property,  final  plans  were  adopted  in 
December,  1891,  construction  was  begun  May  i, 
1892,  and  two  years  later,  under  the  direction  of  our 
Medical  Superintendent,  Dr.  Samuel  B.  Lyon,  all 
the  patients  were  moved  from  the  old  to  this  new 
Bloomingdale.  The  cost  of  the  new  buildings  was 
about  $1,500,000.  From  time  to  time  the  original 
Bloomingdale  site  was  sold  and  now  supplies  room, 
among  other  structures,  for  Columbia  University, 
Barnard  College,  the  Cathedral  of  St.  John  the 
Divine,  St.  Luke's  Hospital,  the  Woman's  Hospital, 
and  the  National  Academy  of  Design.  With  the 
proceeds  of  those  sales  of  the  old  Bloomingdale,  not 
only  was  the  cost  of  the  new  Bloomingdale  met,  but 
the  permanent  endowment  of  the  Society  was  sub- 
stantially increased,  and  Thomas  Eddy  was  proved 
to  have  been  both  a  wise  humanitarian  and  a  far- 
sighted  steward  of  charitable  funds. 


HISTORICAL    REVIEW 

In  their  "Address  to  the  Public"  to  which  I  have 
referred,  issued  when  Bloomingdale  Hospital  was 
opened  in  1821,  the  Governors  of  the  Society  spoke 
of  the  new  conception  of  moral  treatment  of  the 
mentally  afflicted  which  had  been  established  in 
several  European  hospitals  and  which  was  sup- 
planting the  harsh  and  cruel  usage  of  former  days, 
as  "one  of  the  noblest  triumphs  of  pure  and  en- 
lightened benevolence."  In  that  same  spirit  those 
founders  dedicated  themselves  to  the  conduct  of 
this  institution.  Their  devotion  to  the  work  was 
impressive.  Looking  back  on  those  early  days  we 
see  a  constant  personal  attention  to  the  details  of 
institutional  life  that  commands  admiration.  The 
standards  then  set  have  become  a  tradition  that 
has  been  preserved  unbroken  for  a  hundred  years. 
Humane  methods  of  care,  the  progressively  best 
that  medical  science  can  devise,  the  utilization  of  a 
growingly  productive  pursuit  of  research,  have  con- 
sistently marked  the  administration  of  this  great 
trust.  The  Governors  of  to-day  are  as  determined 
as  any  of  their  predecessors  to  maintain  that  ideal 
of  "pure  and  enlightened  benevolence."  New  paths 
are  opening  and  larger  resources  are  becoming  avail- 
able. Under  the  guidance  of  our  distinguished  Medi- 
cal Superintendent,  with  his  able  and  devoted  staff 
of  physicians,  a  broader  and  more  intensive  develop- 

[is] 


A    PSYCHIATRIC   MILESTONE 

ment  is  already  under  way.  Animated  by  that  re- 
solve and  cheered  by  that  prospect,  we  may  thus 
confidently  hope,  as  we  begin  the  second  century 
of  Bloomingdale's  career,  for  results  not  less  fruitful 
and  gratifying  than  those  which  we  celebrate  to-day. 


[16] 


ADDRESS      BY 

DR.    ADOLF    MEYER 


The  Chairman :  In  celebrating  our  centenary  we 
are  naturally  dealing  also  with  the  larger  subject 
of  general  psychiatry.  Our  success  in  this  discussion 
should  be  materially  promoted  by  the  presence  with 
us  of  Dr.  Adolf  Meyer,  Professor  of  Psychiatry  in 
the  Medical  School  of  Johns  Hopkins  University, 
and  Director  of  the  Phipps  Psychiatric  Clinic,  of 
Baltimore.  Before  taking  up  this  important  work 
in  that  famous  medical  centre,  Dr.  Meyer  was  ac- 
tively engaged  for  several  years  in  psychopathic 
work  in  New  York.  He  will  speak  to  us  on  "THE 
CONTRIBUTIONS  OF  PSYCHIATRY  TO  THE  UNDER- 
STANDING OF  LIFE  PROBLEMS." 


DR.  MEYER 

When  Dr.  Russell  honored  me  with  the  invitation 
to  speak  at  this  centenary  celebration  of  the  re- 
nowned Bloomingdale  Hospital,  my  immediate  im- 
pulse was  to  choose  as  my  topic  a  phase  of  psy- 
chiatric development  to  which  this  Hospital  has 
especially  contributed  through  our  greatly  missed 
August  Hoch  and  his  deeply  appreciated  coworker 
Amsden.  I  have  in  mind  the  great  gain  in  con- 
creteness  of  the  physician's  work  with  mind  and 
the  resulting  contribution  of  psychiatry  to  a  better 
knowledge  of  human  life  and  its  problems.  The 
great  gain  this  passing  century  is  able  to  hand  on  to 
its  successor  is  the  clearer  recognition  of  just  what 
the  psychiatrist  actually  works  with  and  works  on. 

Of  all  the  divisions  of  medicine,  psychiatry  has 
suffered  longest  from  man's  groping  for  a  concep- 
tion of  his  own  nature.  Psychiatry  means,  literally, 
the  healing  of  souls.  What  then  do  we  actually 
mean  by  soul  or  by  psyche  ?  This  question  has 
too  long  been  treated  as  a  disturbing  puzzle. 

To-day  we  feel  that  modern  psychiatry  has  found 
itself — through  the  discovery  that,  after  all,  the 
uncritical  common-sense  view  of  mind  and  soul  is 

[21] 


A    PSYCHIATRIC   MILESTONE 

not  so  far  remote  from  a  critical  common-sense  view 
of  the  individual  and  its  life  activity,  freed  from  the 
forbidding  and  confusing  assumptions  through  which 
the  concept  of  mind  and  soul  has  been  held  in  be- 
wildering awe. 

Strange  to  say,  good  old  Aristotle  was  nearer  an 
understanding  than  most  of  the  wise  men  and  women 
that  have  succeeded  him  for  these  more  than  two 
thousand  years.  He  saw  in  the  psyche  what  he 
called  the  form  and  realization  or  fulfilment  of  the 
human  organism;  he  would  probably  now  say  with 
us,  the  activity  and  function  as  an  individual  or 
person. 

Through  the  disharmonies  and  inevitable  disrup- 
tion of  a  self-disorganizing  civilization,  the  Greek  and 
Roman  world  was  plunged  into  the  dark  centuries 
during  which  the  perils  of  the  soul  and  the  sacrificial 
attainment  of  salvation  by  monastic  life  and  cru- 
sades threatened  to  overshadow  all  other  concern. 
This  had  some  inevitable  results:  it  favored  all  those 
views  through  which  the  soul  became  like  a  special 
thing  or  substance,  in  contrast  to  and  yet  a  counter- 
part of  the  physical  body.  As  long  as  there  was  no 
objective  experimental  science,  the  culminating  solu- 
tion of  life  problems  had  to  be  intrusted  to  that  re- 
markable development  of  religious  philosophy  which 
arose  from  the  blending  of  Hebrew  religion  and  tra- 

[22] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

dition  and  the  loftiest  products  of  the  Greek  mind, 
in  the  form  which  St.  Paul  and  the  early  Church 
fathers  gave  to  the  teachings  of  Christ.  From 
being  the  form  and  activation,  or  function,  of  the 
organism  in  life,  the  soul  feature  of  man  was  given 
an  appearance  in  which  it  could  neither  be  grasped 
nor  understood,  nor  shaped,  nor  guided  by  man 
when  it  got  into  trouble.  From  the  Middle  Ages 
there  arose  an  artificial  soul  and  an  artificial  world 
of  souls  presented  as  being  in  eternal  conflict  with 
the  evil  of  the  flesh — and  thus  the  house  of  human 
nature  was  divided  against  itself. 

Science  of  the  nineteenth  century  came  nearer 
bringing  mind  and  body  together  again.  The  new  as- 
tronomical conception  of  the  world  and  the  growing 
objective  experimental  science  gradually  began  to 
command  confidence,  and  from  being  a  destroyer 
of  excessively  dogmatic  notions,  science  began  to 
rise  to  its  modern  constructive  and  creative  position. 
But  the  problem  of  mind  remained  on  a  wrong  basis 
and  still  does  so  even  with  most  scientists.  Too 
much  had  been  claimed  for  the  psyche,  and  because 
of  the  singling  out  of  a  great  world  of  spirit,  the 
world  of  fact  had  been  compromised  and  left  cold 
and  dry  and  unattractive  and  unpromising.  No 
doubt  it  was  necessary  that  the  scientist  should 
become  hardened  and  weaned  from  all  misleading 

[23] 


A    PSYCHIATRIC    MILESTONE 

expectation,  and  shy  of  all  the  spurious  claims  of 
sordid  superstition  and  of  childish  fancy.  He  may 
have  been  unduly  radical  in  cutting  out  everything 
that  in  any  way  recalled  the  misleading  notions. 
In  the  end,  we  had  to  go  through  a  stage  of  psy- 
chology without  a  "soul,"  and  lately  even  a  psy- 
chology without  "consciousness,"  so  that  we  might 
be  safe  from  unscientific  pretensions.  All  the  gyra- 
tions no  doubt  tended  to  retard  the  wholesome  prac- 
tical attack  upon  the  problems  in  the  form  in  which 
we  find  them  in  our  common-sense  life. 

The  first  effort  at  a  fresh  start  tried  to  explain 
everything  rather  one-sidedly  out  of  the  meagre 
knowledge  of  the  body.  Spinoza  had  said  in  his 
remarkable  Ethics  (III,  Prop.  II,  Schol.):  "Nobody 
has  thus  far  determined  what  the  body  can  do,  i.  e., 
nobody  has  as  yet  shown  by  experience  and  trial  what 
the  body  can  do  by  the  laws  of  nature  alone  in  so 
far  as  nature  is  considered  merely  as  corporeal  and 
extended,  and  what  it  cannot  do  save  when  de- 
termined by  mind." 

This  challenge  of  Spinoza's  had  to  be  met.  With 
some  investigators  this  seemed  very  literally  all 
there  was  to  be  done  about  the  study  of  man — to 
show  how  far  the  body  could  explain  the  activity  we 
call  "the  mind."  The  unfortunate  feature  was  that 
they  thought  they  had  to  start  with  a  body  not  only 


PSYCHIATRY   AND    LIFE    PROBLEMS 

with  mind  and  soul  left  out  but  also  with  practical 
disregard  of  the  whole  natural  setting.  They  studied 
little  more  than  corpses  and  experimental  animals, 
and  many  a  critic  wondered  how  such  a  corpse  or 
a  frog  could  ever  show  any  mind,  normal  or  ab- 
normal. To  get  things  balanced  again,  the  vision 
of  man  had  to  expand  to  take  a  sane  and  practical 
view  of  all  of  human  life — not  only  of  its  machinery. 

The  human  organism  can  never  exist  without  its 
setting  in  the  world.  All  we  are  and  do  is  of  the 
world  and  in  the  world.  The  great  mistake  of  an 
overambitious  science  has  been  the  desire  to  study 
man  altogether  as  a  mere  sum  of  parts,  if  possible 
of  atoms,  or  now  of  electrons,  and  as  a  machine, 
detached,  by  itself,  because  at  least  some  points  in 
the  simpler  sciences  could  be  studied  to  the  best 
advantage  with  this  method  of  the  so-called  ele- 
mentalist.  It  was  a  long  time  before  willingness  to 
see  the  large  groups  of  facts,  in  their  broad  relations 
as  well  as  in  their  inner  structure,  finally  gave  us  the 
concept  and  vision  of  integration  which  now  fits 
man  as  a  live  unit  and  transformer  of  energy  into 
the  world  of  fact  and  makes  him  frankly  a  con- 
sciously integrated  psychobiological  individual  and 
member  of  a  social  group. 

It  is  natural  enough  that  man  should  want  to 
travel  on  the  road  he  knows  and  likes  best.  The 

[25] 


A    PSYCHIATRIC   MILESTONE 

philosopher  uses  his  logic  and  analysis  and  synthesis. 
The  introspectionist  wants  to  get  at  the  riddle  of 
the  universe  by  crawling  into  the  innermost  depth 
of  his  own  self-scrutiny,  even  at  the  risk — to  use 
a  homely  phrase — of  drawing  the  hole  in  after  him 
and  losing  all  connection  with  the  objective  world. 
The  physicist  follows  the  reverse  course.  He  gives 
us  the  appreciation  of  the  objective  world  around 
and  in  us.  The  chemist  follows  out  the  analytic 
and  synthetic  possibilities  of  his  atoms  and  ele- 
ments, and  the  biologist  the  growth  and  reproduc- 
tion and  multiplication  of  cells.  Each  sees  an  open 
world  of  possibilities  and  is  ready  to  follow  as  far 
as  facts  will  carry  and  as  far  as  the  imagination  will 
soar.  Each  branch  has  created  its  rules  of  the  game 
culminating  in  the  concept  of  objective  science,  and 
the  last  set  of  facts  to  bring  itself  under  the  rules 
of  objective  science,  and  to  be  accepted,  has  been 
man  as  a  unit  and  personality. 

The  mind  and  soul  of  man  have  indeed  had  a 
hard  time.  To  this  day,  investigators  have  suf- 
fered under  the  dogma  that  mind  must  be  treated 
as  purely  subjective  entity,  something  that  can  be 
studied  only  by  introspection,  or  at  least  only  with 
ultra-accurate  instruments — always  with  the  idea 
that  common  sense  is  all  wrong  in  its  psychology. 
Undoubtedly  it  was,  so  long  as  it  spoke  of  a  mind 

[26] 


PSYCHIATRY    AND    LIFE    PROBLEMS 

and  soul  as  if  what  was  called  so  had  to  be,  even 
during  life,  mysterious  and  inaccessible,  something 
quite  different  from  any  other  fact  of  natural-his- 
tory study. 

The  great  step  was  taken  when  all  of  life  was 
seen  again  in  its  broad  relations,  without  any  special 
theory  but  frankly  as  common  sense  finds  it,  viz., 
as  the  activities  and  behavior  of  definite  individ- 
uals— very  much  as  Aristotle  had  put  it — "living 
organisms  in  their  'form'  or  activity  and  behavior/' 
Psychology  had  to  wake  up  to  studying  other  minds 
as  well  as  one's  own.  Common  sense  has  always 
been  willing  to  study  other  persons  besides  our 
own  selves,  and  that  exactly  as  we  study  single 
organs — viz.,  for  what  they  are  and  do  and  for  the 
conditions  of  success  and  failure.  Nor  do  we  have 
to  start  necessarily  from  so-called  elements.  Prog- 
ress cannot  be  made  merely  out  of  details.  It  will 
not  do  merely  to  pile  up  fragments  and  to  expect 
the  aggregates  to  form  themselves.  It  also  takes  a 
friend  of  facts  with  the  capacity  for  mustering  and 
unifying  them,  as  the  general  musters  his  army. 
Biology  had  to  have  evolutionists  and  its  Darwin 
to  get  on  a  broad  basis  to  start  with,  and  human 
biology,  the  life  of  man,  similarly  had  to  be  con- 
ceived in  a  new  spirit,  with  a  clear  recognition  of 
the  opportunities  for  the  study  of  detail  about  the 

[27] 


A    PSYCHIATRIC   MILESTONE 

brain  and  about  the  conditions  for  its  working  and 
its  proper  support,  but  also  with  a  clear  vision  of 
the  whole  man  and  all  that  his  happiness  and  effi- 
ciency depend  upon. 

All  this  evolution  is  strongly  reflected  in  the 
actual  work  of  psychiatry  and  medicine.  For  a 
time,  it  looked  to  the  physician  as  if  the  physiology 
and  pathology  of  the  body  had  to  make  it  their 
ambition  to  make  wholly  unnecessary  what  tradi- 
tional psychology  had  accumulated,  by  turning  it 
all  into  brain  physiology.  The  "psychological" 
facts  involved  were  undoubtedly  more  difficult  to 
control,  so  much  so  that  one  tried  to  cut  them  out 
altogether.  As  if  foreshadowing  the  later  academic 
"psychology  without  soul  and  consciousness,"  the 
venerable  Superintendent  of  Utica,  Dr.  Gray,  was 
very  proud  when  in  1870  he  had  eliminated  the 
"mental  and  moral  causes"  from  his  statistics  of  the 
Utica  State  Hospital,  hiding  behind  the  dogma  that 
"mind  cannot  become  diseased,  but  only  the  body." 
To-day  "mental  and  moral  causes"  are  recognized 
again  in  truer  form — no  longer  as  mere  ideas  and 
uninvestigated  suppositions  taken  from  uncritical 
histories,  but  as  concrete  and  critically  studied  life 
situations  and  life  factors  and  life  problems.  Our 
patients  are  not  sick  merely  in  an  abstract  mind, 
but  by  actually  living  in  ways  which  put  their  mind 

[28] 


PSYCHIATRY   AND    LIFE    PROBLEMS 

and  the  entire  organism  and  its  activity  in  jeopardy, 
and  we  are  now  free  to  see  how  this  happens — since 
we  study  the  biography  and  life  history,  the  resources 
of  adaptation  and  of  shaping  the  life  to  success  or 
to  failure. 

The  study  of  life  problems  always  concerns  itself 
with  the  interaction  of  an  individual  organism  with 
life  situations.  The  first  result  of  a  recognition  of 
this  fact  was  a  more  whole-hearted  and  practical 
concept  of  personality. 

In  1903  I  put  together  for  the  first  time  my  analy- 
sis of  the  neurotic  personality,  which  was  soon  fol- 
lowed by  a  series  of  studies  on  the  influences  of  the 
mental  factors,  and  in  1908  a  paper  on  "What  Do 
Histories  of  Cases  of  Insanity  Teach  Us  Concerning 
Preventive  Mental  Hygiene  During  the  Years  of 
School  Life  ?"  All  this  was  using  for  psychiatry  the 
growing  appreciation  of  a  broad  biological  view-point 
in  its  concrete  application.  It  was  a  reaction  against 
the  peculiar  fear  of  studying  the  facts  of  life  simply 
and  directly  as  we  find  and  experience  them — scoffed 
at  because  it  looked  as  if  one  was  not  dealing  with 
dependable  and  effective  data.  Many  of  the  factors 
mentioned  as  causes  do  not  have  the  claimed  effects 
with  sufficient  regularity.  It  is  quite  true  that  not 
everybody  is  liable  to  any  serious  upset  by  several 
of  the  handicaps  sometimes  found  to  be  disastrous 


A    PSYCHIATRIC   MILESTONE 

during  the  years  of  development;  but  we  have 
learned  to  see  more  clearly  why  the  one  person  does 
and  the  other  does  not  suffer.  Evidently,  not  every- 
body who  is  reserved  and  retiring  need  be  in  danger 
of  mental  disorder,  yet  there  are  persons  of  just  this 
type  of  make-up  that  are  less  able  than  others  to 
stand  the  strains  of  isolation,  of  inferiority  feeling, 
of  exalted  ambitions  and  one-sided  longings,  intol- 
erable desires,  etc.  The  same  individual  difference 
of  susceptibility  holds  even  for  alcohol.  With  this 
recognition  we  came  to  lay  stress  again  on  the 
specific  factors  which  make  for  the  deterioration  of 
habits,  for  tantrums  with  imaginations,  and  for 
drifting  into  abnormal  behavior,  and  conditions 
incompatible  with  health. 

It  was  at  this  point  that  our  great  indebtedness 
to  the  Bloomingdale  Hospital  began.  Dr.  August 
Hoch,  then  First  Assistant  of  the  Bloomingdale  Hos- 
pital, began  to  swing  more  and  more  toward  the 
psychobiological  trend  of  views,  and  with  his  devoted 
and  very  able  friend  Amsden  he  compiled  that  re- 
markable outline,*  which  was  the  first  attempt  to 
reduce  the  new  ideals  of  psychobiology  to  a  practical 
scheme  of  personality  study — that  clear  and  plain 

*  A  Guide  to  the  Descriptive  Study  of  the  Personality,  with  Special 
Reference  to  the  Taking  of  Anamneses  of  Cases  with  Psychoses,  by 
Dr.  August  Hoch  and  Dr.  George  S.  Amsden. 

[30] 


PSYCHIATRY   AND    LIFE    PROBLEMS 

questionnaire  going  directly  at  human  traits  and 
reactions  such  as  we  all  know  and  can  see  at  work 
without  any  special  theories  or  instruments. 

After  studying  in  each  patient  all  the  non-mental 
disorders  such  as  infections,  intoxications,  and  the 
like,  we  can  now  also  attack  the  problems  of  life 
which  can  be  understood  only  in  terms  of  plain  and 
intelligible  human  relations  and  activities,  and  thus 
we  have  learned  to  meet  on  concrete  ground  the  real 
essence  of  mind  and  soul — the  plain  and  intelligible 
human  activities  and  relations  to  self  and  others. 
There  are  in  the  life  records  of  our  patients  cer- 
tain ever-returning  tendencies  and  situations  which 
a  psychiatry  of  exclusive  brain  speculation,  auto- 
intoxications, focal  infections,  and  internal  secre- 
tions could  never  have  discovered. 

Much  is  gained  by  the  frank  recognition  that  man 
is  fundamentally  a  social  being.  There  are  reac- 
tions in  us  which  only  contacts  and  relations  with 
other  human  beings  can  bring  out.  We  must  study 
men  as  mutual  reagents  in  personal  affections  and 
aversions  and  their  conflicts;  in  the  desires  and  satis- 
factions of  the  simpler  appetites  for  food  and  per- 
sonal necessities;  in  the  natural  interplay  of  antici- 
pation and  fulfilment  of  desires  and  their  occasional 
frustration;  in  the  selection  of  companionship  which 
works  helpfully  or  otherwise — for  the  moment  or 


A    PSYCHIATRIC    MILESTONE 

more  lastingly  throughout  the  many  vicissitudes 
of  life.  All  through  we  find  situations  which  create 
a  more  or  less  personal  bias  and  chances  for  success 
or  failure,  such  as  simpler  types  of  existence  do  not 
produce.  They  create  new  problems,  and  produce 
some  individuals  of  great  sensitiveness  and  others 
with  immunity — and  in  this  great  field  nothing  will 
replace  a  simple  study  of  the  life  factors  and  the 
social  and  personal  life  problems  and  their  work- 
ing— the  study  of  the  real  mind  and  the  real  soul — 
i.  e.,  human  life  itself.  Looking  back  then  this 
practical  turn  has  changed  greatly  the  general  view 
as  to  what  should  be  the  chief  concern  of  psychology. 
One  only  need  take  up  a  book  on  psychology  to  see 
what  a  strong  desire  there  always  was  to  contrast 
a  pure  psychology  and  an  applied  psychology,  and  to 
base  a  new  science  directly  on  the  new  acquisitions 
of  the  primary  sciences  such  as  anatomy  and  his- 
tology of  the  nervous  system.  There  was  a  quest 
for  the  elements  of  mind  and  their  immediate  corre- 
lation with  the  latest  discoveries  in  the  structure  of 
the  brain.  The  centre  theory  and  the  cell  and  neu- 
rone theory  seemed  obligatory  starting-points.  To- 
day we  have  become  shy  of  such  postulates  of  one- 
sided not  sufficiently  functional  materialism.  We 
now  call  for  an  interest  in  psychobiological  facts  in 
terms  of  critical  common  sense  and  in  their  own 

[32] 


PSYCHIATRY   AND    LIFE    PROBLEMS 

right— largely  a  product  of  psychiatry.  There  al- 
ways is  a  place  for  elements,  but  there  certainly  is 
also  a  place  for  the  large  momentous  facts  of  human 
life  just  as  we  find  and  live  it. 

Thus  psychiatry  has  opened  to  us  new  conceptions 
and  understandings  of  the  relation  of  child  and 
mother,  child  and  father,  the  child  as  a  reagent  to 
the  relations  between  mother  and  father,  brothers 
and  sisters,  companions  and  community — in  the 
competitions  of  real  concrete  life.  It  has  furnished 
a  concrete  setting  for  the  interplay  of  emotions  and 
their  effects. 

It  has  led  us  from  a  cold  dogma  of  blind  heredity 
and  a  wholesale  fatalistic  asylum  scheme,  to  an  under- 
standing of  individual,  familiar,  and  social  adjust- 
ments, and  a  grasp  on  the  factors  which  we  can  con- 
sider individually  and  socially  modifiable.  We  have 
passed  from  giving  mere  wholesale  advice  to  a  con- 
scientious study  of  the  problems  of  each  unit,  and 
at  the  same  time  we  have  developed  a  new  and  sen- 
sible approach  to  mental  hygiene  and  prevention, 
as  expressed  in  the  comprehensive  surveys  of  State 
and  community  work  and  even  more  clearly  in  the 
development  of  helps  to  individuals  in  finding  them- 
selves, and  in  the  work  in  schools  to  reach  those  who 
need  a  special  adaptation  of  aims  and  means.  To 
the  terrible  emergency  of  the  war  it  was  possible  to 

[33] 


A    PSYCHIATRIC    MILESTONE 

bring  experienced  men  and  women  as  physicians 
and  nurses,  and  how  much  was  done,  only  those 
can  appreciate  who  have  seen  the  liberality  with 
which  all  the  hospitals,  and  Bloomingdale  among 
the  first,  contributed  more  than  their  quota  of  help, 
and  all  the  assistance  that  could  possibly  be  offered 
to  returning  victims  for  their  readjustment. 

It  is  natural  enough  that  psychiatry  should  have 
erred  in  some  respects.  We  had  forced  upon  us  the 
herding  together  of  larger  numbers  of  patients  than 
can  possibly  be  handled  by  one  human  working  unit 
or  working  group.  The  consequence  was  that  there 
arose  a  narrowing  routine  and  wholesale  classifica- 
tions and  a  loss  of  contact  with  the  concrete  needs 
of  the  individual  case;  that  very  often  progress  had 
to  come  from  one-sided  enthusiasts  or  even  out- 
siders, who  lost  the  sense  of  proportion  and  magnified 
points  of  relative  importance  until  they  were  sup- 
posed to  explain  everything  and  to  be  cure-alls. 
We  are  all  inclined  to  sacrifice  at  the  altar  of  excessive 
simplicity,  especially  when  it  suits  us;  we  become 
"  single-taxers "  and  favor  wholesale  legislation  and 
exclusive  State  care  when  our  sense  for  democratic 
methods  has  gone  astray.  Human  society  has  dealt 
with  the  great  needs  of  psychiatry  about  as  it  has 
dealt  with  the  objects  of  charity,  only  in  some  ways 
more  stingily,  with  a  shrewd  system  and  unfortu- 

[34] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

nately  often  with  a  certain  dread  of  the  workers 
themselves  and  of  their  enthusiasm  and  demands. 
Law  and  prejudice  surrounded  a  great  share  of  the 
work  with  notions  of  stigma  and  hopelessness  and 
weirdness— while  to  those  who  see  the  facts  in  terms 
of  life  problems  there  can  be  but  few  more  inspir- 
ing tasks  than  watching  the  unfolding  of  the  prob- 
lematic personality,  seeking  and  finding  its  proper 
settings,  and  preventing  the  clashes  and  gropings 
in  maladjustments  and  flounderings  of  fancy  and 
the  faulty  use  and  nutrition  of  the  brain  and  of  the 
entire  organism. 

What  a  difference  between  the  history  of  a  patient 
reported  and  studied  and  advised  by  the  well-trained 
psychiatrist  of  to-day  and  the  account  drawn  up 
by  the  statistically  minded  researcher  or  the  physi- 
cian who  wants  to  see  nothing  but  infections  or 
chemistry  and  hypotheses  of  internal  secretion. 
What  a  different  chance  for  the  patient  in  his  treat- 
ment, in  contrast  to  what  the  venerable  Gait  of 
Virginia  reports  as  the  conception  of  treatment 
recommended  by  a  great  leader  of  a  hundred  years 
ago:  "Mania  in  the  first  stage,  if  caused  by  study, 
requires  separation  from  books.  Low  diet  and  a 
few  gentle  doses  of  purging  physic;  if  pulse  tense, 
ten  or  twelve  ounces  of  blood  [not  to  be  given  but 
to  be  taken  !].  In  the  high  grade,  catch  the  patient's 

[35] 


A    PSYCHIATRIC    MILESTONE 

eye  and  look  him  out  of  countenance.  Be  always 
dignified.  Never  laugh  at  or  with  them.  Be  truth- 
ful. Meet  them  with  respect.  Act  kindly  toward 
them  in  their  presence.  If  these  measures  fail, 
coercion  if  necessary.  Tranquillizing  chair.  Strait 
waistcoat.  Pour  cold  water  down  their  sleeves.  The 
shower  bath  for  fifteen  or  twenty  minutes.  Threaten 
them  with  death.  Chains  seldom  and  the  whip 
never  required.  Twenty  to  forty  ounces  of  blood, 
unless  fainting  occurs  previously;  .  .  .  etc." 

To-day  an  understanding  of  the  life  history,  of 
the  patient's  somatic  and  functional  assets  and 
problems,  likes  and  dislikes,  the  problem  presented 
by  the  family,  etc. ! 

So  much  for  the  change  within  and  for  psychiatry. 
How  about  psychiatry's  contribution  beyond  its 
own  narrower  sphere  ?  It  has  led  us  on  in  philos- 
ophy, it  has  brought  about  changes  in  our  attitude  to 
ethics,  to  social  study,  to  religion,  to  law,  and  to  life 
in  general.  Psychiatric  work  has  undoubtedly  in- 
tensified the  hunger  for  a  more  objective  and  yet 
melioristic  and  really  idealistic  philosophical  con- 
ception of  reality,  such  as  has  been  formulated  in 
the  modern  concept  of  integration. 

Philosophical  tradition,  logic,  and  epistemology 
alike  had  all  conspired  to  make  as  great  a  puzzle  as 
possible  of  the  nature  of  mental  life,  of  life  itself,  and 

[36] 


PSYCHIATRY   AND    LIFE    PROBLEMS 

of  all  the  fundamental  principles,  so  much  so  that 
as  a  result  anything  resembling  or  suggesting  philos- 
ophy going  beyond  the  ordinary  traditions  has  got 
into  poor  repute  in  our  colleges  and  universities  and 
among  those  of  practical  intelligence.  The  conse- 
quence is  that  the  student  and  the  physician  are  apt 
to  be  hopeless  and  indifferent  concerning  any  effort 
at  orderly  thinking  on  these  problems.* 

Most  of  us  grew  up  with  the  attitude  of  a  fatalistic 
intellectual  hopelessness.  How  could  we  ever  be 
clear  on  the  relation  of  mind  and  body?  How 
could  mind  and  soul  ever  arise  out  of  matter  ?  How 
can  we  harmonize  strict  science  with  what  we  try 
to  do  in  our  treatment  of  patients  ?  How  can  we, 
with  our  mechanistic  science,  speak  of  effort,  and 
of  will  to  do  better  ?  How  can  we  meet  the  invec- 
tives against  the  facts  of  matter  on  the  part  of  the 
opposing  idealistic  philosophies  and  their  uncritical 
exploitations  in  "New  Thought"  —  i.  e.,  really  the 
revival  of  archaic  thought  ?  It  is  not  merely  medical 
usefulness  that  forced  these  broad  issues  on  many  a 
thinking  physician,  but  having  to  face  the  facts  all 
the  time  in  dealing  with  a  living  human  world.  The 
psychopathologist  had  to  learn  to  do  more  than  the 
so-called  "  elementalist "  who  always  goes  back  to 

*  See,  for  instance,  Moebius,  The  Hopelessness  of  All  Psychology, 
reviewed  in  the  Psychological  Bulletin,  vol.  IV,  1907,  pp.  170-179. 

[37] 


A    PSYCHIATRIC    MILESTONE 

the  elements  and  smallest  units  and  then  is  apt 
to  shirk  the  responsibility  of  making  an  attempt 
to  solve  the  concrete  problems  of  greater  com- 
plexity. The  psychiatrist  has  to  study  individuals 
and  groups  as  wholes,  as  complex  units,  as  the 
"you"  or  "he"  or  "she"  or  "they"  we  have  to 
work  with.  We  recognize  that  throughout  nature 
we  have  to  face  the  general  principle  of  unit-forma- 
tion, and  the  fact  that  the  new  units  need  not  be 
like  a  mere  sum  of  the  component  parts  but  can  be 
an  actually  new  entity  not  wholly  predictable  from 
the  component  parts  and  known  only  through  ac- 
tual experience  with  the  specific  product.  Hydrogen 
and  oxygen,  it  is  true,  can  form  simple  mixtures, 
but  when  they  make  an  actual  chemical  integration 
we  get  a  new  specific  type  of  substance,  water,  be- 
having and  dividing  according  to  its  own  laws  and 
properties  in  a  way  not  wholly  predictable  from  just 
what  we  know  of  hydrogen  and  oxygen  as  such. 
Analogy  prompts  us  to  see  in  plants  and  animals 
products  of  physics  and  chemistry  and  organization, 
although  the  peculiarity  of  the  product  makes  us 
recognize  certain  specificities  of  life  not  contained  in 
the  theory  of  mere  physics  and  chemistry.  All  the 
facts  of  experience  prompt  us  to  see  in  mentation  a 
biological  function,  and  we  are  no  longer  surprised 
to  find  this  product  of  integration  so  different  from 

[38] 


PSYCHIATRY    AND   LIFE    PROBLEMS 

the  nature  and  functions  of  all  the  component  parts. 
All  the  apparent  discontinuities  in  the  intrinsic 
harmony  of  facts,  on  the  one  hand,  and  the  apparent 
impossibility  of  accounting  for  new  features  and 
peculiarities  of  the  new  units,  are  shown  to  be  a 
general  feature  of  nature  and  of  facts :  integration  is 
not  mere  summation,  but  a  creation  of  ever-new 
types  and  units,  with  superficial  discontinuities  and 
with  their  own  new  denominators  of  special  peculi- 
arities; hence  there  is  no  reason  to  think  of  an  insur- 
mountable and  unique  feature  in  the  origin  of  life, 
nor  even  of  mentally  integrated  life;  no  need  of  spe- 
cial mystical  sparks  of  life,  of  a  mysterious  spirit, 
etc.;  but — and  this  is  the  important  point — also  no 
need  of  denying  the  existence  of  all  the  evidence 
there  may  be  of  facts  which  we  imply  when  we  use 
the  deeply  felt  concepts  of  mind  and  soul.  In  other 
words,  we  do  not  have  to  be  mind-shy  nor  body-shy 
any  longer. 

The  inevitable  problem  of  having  to  study  other 
persons  as  well  as  ourselves  necessarily  leads  us  on 
to  efforts  at  solution  of  other  philosophical  problems, 
the  problem  of  integrating  materialism  and  idealism, 
mechanism  and  relative  biological  determinism  and 
purpose,  etc.  Man  has  to  live  with  the  laws  of 
physics  and  chemistry  unbroken  and  in  harmony 
with  all  that  is  implied  in  the  laws  of  heredity  and 

[39] 


A    PSYCHIATRIC   MILESTONE 

growth  and  function  of  a  biological  organism.  Yet 
what  might  look  like  a  limitation  is  really  his  strength 
and  safe  foundation  and  stability.  On  this  ground, 
man's  biological  make-up  has  a  legitimate  sphere  of 
growth  and  expansion  shared  by  no  other  type  of 
being.  We  pass  into  every  new  moment  of  time  with 
a  preparedness  shown  in  adaptive  and  constructive 
activity  as  well  as  structure,  most  plastic  and  far- 
reaching  in  the  greatest  feat  of  man,  that  of  imagina- 
tion. Imagination  is  not  a  mere  duplication  of 
reality  in  consciousness  and  subjectivity;  it  is  a  sub- 
stitute in  a  way,  but  actually  an  amplification,  and 
often  a  real  addition  to  what  we  might  otherwise 
call  the  "  crude  world,"  integrated  in  the  real  activi- 
ties of  life,  a  new  creation,  an  ever-new  growth,  seen 
in  its  most  characteristic  form  in  choice  and  in  any 
new  volition.  Hence  the  liberating  light  which 
integration  and  the  concepts  of  growth  and  time 
throw  on  the  time-honored  problem  of  absolute  and 
relative  determinism  and  on  the  relation  of  an  ultra- 
strict  "science"  with  common  sense. 

In  logic,  too,  we  are  led  to  special  assertions.  We 
are  forced  to  formulate  "open  definitions,"  i.  e.,  we 
have  to  insist  on  the  open  formulation  of  tendencies 
rather  than  "closed  definitions."  We  deal  with  rich 
potentialities,  never  completely  predictable. 

This  background  and  the  demands  of  work  in 

[40] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

guiding  ourselves  and  others  thus  come  to  lead  us 
also  into  practical  ethics,  with  a  new  conception  of 
the  relation  of  actual  and  experimental  determinism 
and  of  what  "free  will"  we  may  want  to  speak  of, 
with  a  new  emphasis  on  the  meaning  of  choice,  of 
effort,  and  of  new  creation  out  of  new  possibilities 
presented  by  the  ever-newly-created  opportunities 
of  ever-new  time.  We  get  a  right  to  the  type  of 
voluntaristic  conception  of  man  which  most  of  us 
live  by — with  a  reasonable  harmony  between  our 
science  and  our  pragmatic  needs  and  critical  com- 
mon sense. 

The  extent  to  which  we  can  be  true  to  the  material 
foundations  and  yet  true  to  a  spiritual  goal,  ulti- 
mately measures  our  health  and  natural  normality 
and  the  value  of  our  morality.  Nature  shapes  her 
aims  according  to  her  means.  Would  that  every  man 
might  realize  this  simple  lesson  and  maxim — there 
would  be  less  call  for  a  rank  and  wanton  hankering 
for  relapses  into  archaic  but  evidently  not  wholly 
outgrown  tendencies  to  the  assumption  of  "omnipo- 
tence of  thought,"  revived  again  from  time  to  time 
as  "New  Thought."  Psychiatry  restores  to  science 
and  to  the  practical  mind  the  right  to  reinclude 
rationally  and  constructively  what  a  narrower  view 
of  science  has,  for  a  time  at  least,  handed  over 
unconditionally  to  uncritical  fancy.  But  the  only 

[41] 


A    PSYCHIATRIC    MILESTONE 

way  to  make  unnecessary  astrology  and  phrenology 
and  playing  with  mysticism  and  with  Oliver  Lodge's 
fancies  of  the  revelation  of  his  son  Raymond,  is  to 
recognize  the  true  needs  and  yearnings  of  man  and 
to  show  nature's  real  ways  of  granting  appetites 
and  satisfactions  that  are  wholesome. 

Hereby  we  have  indeed  a  contribution  to  biolog- 
ically sound  idealism:  a  clearer  understanding  of 
how  to  blend  fact  and  ambition,  nature  and  ideal — 
an  ability  to  think  scientifically  and  practically  and 
yet  idealistically  of  matters  of  real  life. 

To  come  back  to  more  concrete  problems  again,  a 
wider  grasp  of  what  psychiatry  may  well  furnish  us 
helps  toward  a  new  ethical  goal  in  our  social  con- 
science. The  nineteenth  century  brought  us  the 
boon  and  the  bane  of  industrialism.  More  and 
more  of  the  pleasures  and  satisfactions  of  creation 
and  production  and  of  the  natural  rewards  of  the 
daily  labor  drifted  away  from  the  sight  and  control 
of  the  worker,  who  now  rarely  sees  the  completed 
result  of  his  work  as  the  farmer  or  the  artisan  used 
to  do.  Few  workers  have  the  experience  of  getting 
satisfaction  from  direct  pride  in  the  end  result; 
as  soon  as  the  product  is  available,  a  set  of  traders 
carries  it  to  the  markets  and  a  set  of  financiers  de- 
termines, in  fact  may  already  have  determined,  the 
reward — just  as  the  reward  of  the  farmer  is  often 

[42] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

settled  for  him  by  astounding  speculations  long  be- 
fore the  crop  is  at  hand.  There  is  a  field  for  a  new 
conscience  heeding  the  needs  of  fundamental  satisfac- 
tions of  man  so  well  depicted  by  Carlton  Parker, 
and  psychiatric  study  furnishes  much  concrete  ma- 
terial for  this  new  conscience  in  industrial  relations— 
with  a  better  knowledge  of  the  human  needs  of  all 
the  participants  in  the  great  game  of  economic  life. 
Psychiatry  gives  us  also  a  new  appreciation  of 
the  religious  life  and  needs  of  our  race.  Man's 
religion  shows  in  his  capacity  to  feel  and  grasp  his 
relations  and  responsibility  toward  the  largest  unit 
or  force  he  can  conceive,  and  his  capacity  for  faith 
and  hope  in  a  deeper  and  more  lasting  interde- 
pendence of  individual  and  race  with  the  Ruler  or 
rules  of  the  Universe.  Whatever  form  it  may  take 
expresses  his  capacity  to  feel  himself  in  humility 
and  faith,  and  yet  with  determination,  a  more  or 
less  responsible  part  of  the  greatest  unit  he  can  grasp. 
The  form  this  takes  is  bound  to  vary  individually. 
As  physicians  we  learn  to  respect  the  religious  views 
of  our  fellow  beings,  whatever  they  may  be;  because 
we  are  sure  that  we  have  the  essentials  in  common; 
and  with  this  emphasis  on  what  we  have  in  common, 
we  can  help  in  attaining  the  individually  highest 
attainable  truth  without  having  to  be  destructive. 
We  all  recognize  relations  that  go  beyond  individual 

[43] 


A    PSYCHIATRIC    MILESTONE 

existence,  lasting  and  "more  than  biological"  rela- 
tions, and  it  is  the  realization  of  these  conceptions 
intellectually  and  emotionally  true  to  our  individual 
and  group  nature  that  constitutes  our  various  re- 
ligions and  faiths.  Emphasizing  what  we  have  in 
common,  we  become  tolerant  of  the  idea  that  prob- 
ably the  points  on  which  we  differ  are,  after  all, 
another's  best  way  of  expressing  truths  which  our 
own  nature  may  picture  differently  but  would  not 
want  to  miss  in,  or  deny  to,  the  other.  One  of  the 
evidences  of  the  great  progress  of  psychiatry  is  that 
we  have  learned  to  be  more  eager  to  see  what  is  sane 
and  strong  and  constructively  valuable  even  in  the 
strange  notions  of  our  patients,  and  less  eager  to 
call  them  queer  and  foolish.  A  delusion  may  con- 
tain another  person's  attempt  at  stating  truth.  The 
goal  of  psychiatry  and  of  sound  common  sense  is 
truth  free  of  distortion.  Many  a  strange  religious 
custom  and  fancy  has  been  brought  nearer  our  under- 
standing and  appreciation  since  we  have  learned  to 
respect  the  essential  truth  and  individual  and  group 
value  of  fancy  and  feeling  even  in  the  myths  and  in 
the  religious  conceptions  of  all  races. 

Among  the  most  interesting  formulations  and  po- 
tential contributions  of  psychiatry  are  those  reach- 
ing out  toward  jurisprudence.  Psychiatry  deals 
pre-eminently  with  the  variety  and  differences  of 

[44] 


human  personalities.  To  correct  or  supplement  a 
human  system  apparently  enslaved  by  concern  about 
precedent  and  baffling  rules  of  evidence  inherited 
from  the  days  of  cruel  and  arbitrary  kings,  the  de- 
mand for  justice  has  called  for  certain  remedies. 
Psychiatry  still  plays  a  disgraceful  role  in  the  so- 
called  expert  testimony,  largely  a  prostitution  of 
medical  authority  in  the  service  of  legal  methods. 
Yet,  out  of  it  all  there  has  arisen  the  great  usefulness 
of  the  psychiatrist  in  the  juvenile  and  other  courts. 
There  it  is  shown  that  if  psychiatry  is  to  help,  it 
should  be  taken  for  granted  that  the  person  indicted 
on  a  charge  should  thereby  become  subject  to  a 
complete  and  unreserved  study  of  all  the  facts, 
subject  to  cross-examination,  to  be  sure,  but  before 
all  accessible  to  complete  and  unreserved  study. 
This  would  mean  a  substantial  participation  of  law 
in  the  promotion  of  knowledge  of  facts  and  con- 
structive activity,  and  a  conception  of  indetermi- 
nate sentence  not  merely  in  the  service  of  leniency 
but  in  the  service  of  the  best  protection  of  the  public, 
and,  if  necessary,  lasting  detention  of  those  who 
cannot  be  reformed,  before  they  have  had  to  do 
their  worst.  Whoever  is  clearly  indicted  for  break- 
ing the  laws  of  social  compatibility  should  not  merely 
invite  a  spirit  of  revenge,  but  should,  through  the 
indictment,  surrender  automatically  to  legalized  au- 

[45] 


A    PSYCHIATRIC   MILESTONE 

thority  endowed  with  the  right  and  duty  of  an  un- 
limited investigation  of  the  facts  as  they  are. 

Looking  back  then,  you  can  see  how  the  history 
of  the  human  thought  about  what  we  call  mind  and 
psyche  displayed  some  strange  reactions  of  the  prac- 
cal  man,  the  scientist,  the  philosopher,  and  theo- 
logian toward  one  of  the  most  important  and  prac- 
tical problems.  It  is  difficult  to  realize  what  it 
means  to  arrive  at  ever-more-workable  formulations 
and  methods  of  approach.  We  do  not  have  to  be 
mind-shy  or  body-shy  any  longer.  To-day  we  can 
attack  the  facts  as  we  find  them,  without  that  dis- 
turbing obsession  of  having  to  translate  them  first 
into  something  artificial  before  we  can  really  study 
them  and  work  with  them.  Since  we  have  reached 
a  sane  pluralism  with  a  justifiable  conviction  of  the 
fundamental  consistency  of  it  all,  a  satisfaction 
with  what  we  modestly  call  formulation  rather  than 
definition  and  with  an  appreciation  of  relativity,  we 
have  at  last  an  orderly  and  natural  field  and  method 
from  which  nobody  need  shy. 

The  century  that  has  passed  since  the  inspiration 
of  a  few  men  of  the  Society  of  the  New  York  Hospital 
to  provide  for  the  mentally  sick  has  cleared  the 
atmosphere  a  great  deal.  We  can  start  the  second 
century  freer  and  unhampered  in  many  ways.  Much 
has  been  added,  and  more  than  ever  do  we  appre- 

[46] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

ciate  the  position  of  just  such  a  hospital  as  that  of 
Bloomingdale  as  a  centre  of  healing  and  as  a  leader 
of  public  opinion  and  as  a  contributor  to  progress. 

The  Bloomingdale  Hospital  has  a  remarkable 
function.  It  is  a  more  or  less  privileged  forerunner 
in  standards  and  policies.  Without  having  to  carry 
the  burdens  of  the  whole  State  with  its  sweeping 
and  sometimes  distant  power  and  its  forced  economy, 
a  semiprivate  hospital  like  Bloomingdale  aims  to 
minister  to  a  slightly  select  group,  especially  those 
who  are  in  the  difficult  position  of  greater  sensitive- 
ness but  moderate  means  in  days  of  sickness.  It 
serves  the  part  of  our  community  which  more  than 
any  other  sets  the  pace  of  the  civilization  about 
us — the  intelligent  aspiring  workers  who  may  not 
have  reached  the  goal  of  absolute  financial  inde- 
pendence. It  creates  the  standard  of  which  we  may 
dream  that  it  might  become  the  standard  of  the 
whole  State. 

When  we  review  the  roster  of  Superintendents— 
from  John  Neilson  to  Pliny  Earle  and  from  Charles 
Nichols,  Tilden  Brown,  and  Samuel  Lyon  down  to 
the  present  head,  our  highly  esteemed  friend  and  co- 
worker  William  L.  Russell — and  the  names  of  the 
members  of  the  staff,  many  of  whom  have  reached 
the  highest  places  in  the  profession,  and  last,  but  not 
least,  the  names  of  the  Governors  of  The  Society  of 

[47] 


A    PSYCHIATRIC    MILESTONE 

the  New  York  Hospital,  we  cannot  help  being  im- 
pressed by  the  forceful  representation  of  both  the 
profession  and  the  public,  and  we  recognize  the  wide 
range  of  influence. 

Instead  of  depending  on  frequently  changing  poli- 
cies regulated  from  the  outside  under  the  influence 
of  the  greater  and  lesser  lights  and  exigencies  of  State 
and  municipal  organization,  the  New  York  Hospital 
has  its  self-perpetuating  body  of  Governors  chosen 
from  the  most  public-spirited  and  thoughtful  repre- 
sentatives of  our  people.  Bloomingdale  thus  has 
always  had  a  remarkable  Board  of  Governors,  who, 
from  contact  with  the  General  Hospital  and  with 
this  special  division,  are  in  an  unusual  position  to  see 
the  practical  aspects  of  the  great  change  that  is  now 
taking  place.  You  see  how  the  division  of  psychiatry 
has  developed  from  practically  a  detention-house  to 
an  asylum,  and  finally  to  a  hospital  with  all  the 
medical  equipment  and  laboratories  of  the  General 
Hospital.  And  you  begin  to  see  psychiatry,  with  its 
methods  of  study  and  management  of  life  problems 
as  well  as  of  specific  brain  diseases,  infections,  and 
gastrointestinal  and  endocrine  conditions,  become 
more  and  more  helpful,  even  a  necessity,  in  the  wards 
and  dispensary  of  the  General  Hospital  on  i6th 
Street.  The  layman  cannot,  perhaps,  delve  profita- 
bly into  the  details  of  such  a  highly  and  broadly 

[48} 


PSYCHIATRY   AND    LIFE    PROBLEMS 

specialized  type  of  work.  But  he  can  readily  take  a 
share  in  the  best  appreciation  of  the  general  philos- 
ophy and  policy  of  it  all. 

The  shaping  of  the  policy  of  a  semiprivate 
hospital  is  not  quite  as  simple  as  shaping  that 
of  a  State  Hospital  with  its  well-defined  districts 
and  geographically  marked  zones  of  responsibility. 
Bloomingdale  has  its  sphere  of  influence  marked  by 
qualitative  selection  rather  than  by  a  formal  con- 
sideration. It  does  not  pose  as  an  invidious  con- 
trast to  the  State  Hospital,  and  yet  it  is  intended  to 
solve  in  a  somewhat  freer  and  more  privileged  man- 
ner the  problem  of  providing  for  the  mentally  sick 
of  a  more  or  less  specific  hospital  constituency,  the 
constituency  of  the  New  York  Hospital;  and  since 
it  reaches  the  most  discriminating  and  thinking  part 
of  our  population,  it  has  the  most  wonderful  oppor- 
tunity to  shape  public  opinion.  Like  all  psychi- 
atrical institutions,  it  has  to  live  down  the  tradi- 
tional notions  of  the  half-informed  public;  it  has  to 
make  conspicuous  the  change  of  spirit  and  the  better 
light  in  which  we  see  our  field  and  responsibilities. 
This  organization  can  show  that  it  is  not  mere  in- 
sanity but  the  working  out  of  life  problems  that  such 
a  hospital  as  this  is  concerned  with.  The  conditions 
for  which  it  cares  are  many.  Some  of  them  are  all 
that  which  tradition  and  law  stamp  as  insanity. 

[49] 


A    PSYCHIATRIC    MILESTONE 

But  see  what  a  change.  Seventy-five  per  cent  of  the 
patients  are  voluntary  admissions;  and  more  and 
more  will  be  able  to  use  the  helps  when  they  begin 
to  feel  the  need,  not  merely  when  it  becomes  an  en- 
forced necessity. 

By  creating  for  this  Hospital  a  liberal  foundation, 
by  completing  its  equipment  so  as  to  make  possible 
a  free  exchange  of  patients  and  of  workers  from  the 
Hospital  in  the  city  and  this  place  in  the  country, 
much  has  been  done  and  more  will  be  done  to  set  a 
living  example  of  the  very  spirit  of  modern  psycho- 
pathology  and  psychiatry.  We  know  now  that  from 
10  to  40  per  cent  of  the  patients  of  the  gynecologist, 
the  gastroenterologist,  and  the  internist  generally 
would  be  better  treated  if  a  study  of  the  life  problems 
were  added  to  that  of  the  special  organs  and  func- 
tions. To  meet  this  need  it  should  be  possible  to 
have  enough  workers  in  this  branch  of  the  Hospital 
to  take  their  share  of  the  consulting  and  co-opera- 
tion work  in  the  wards  and  dispensary  of  the  General 
Hospital,  and  perhaps  even  in  the  schools  provided 
for  the  same  type  of  people  from  which  you  draw  your 
patients.  The  grouping  of  the  patients  can  be  such 
that  the  old  prejudices  need  not  reach  far  into  the 
second  century  of  the  life  of  the  Hospital.  With  a 
man  of  the  vision  and  practical  experience  of  Dr. 
Russell,  there  is  no  need  for  an  outsider  to  conjure 

[so] 


PSYCHIATRY   AND   LIFE    PROBLEMS 

up  a  picture  of  special  practical  achievements  as  I 
have  done  of  the  more  general  principles  to-day. 

An  institution  is  more  than  a  human  life.  Many 
ambitions  combine  and  become  part  of  a  group  spirit 
permeating  the  organization  and  reaching  their  ful- 
filment in  the  succession  of  leaders.  The  life  and 
growth  and  happy  self-realization  of  an  institution  is 
not  the  bricks  and  mortar — it  is  a  living  and  elastic 
entity — never  too  stable,  never  too  finished,  a  grow- 
ing and  plastic  plant — to  use  a  metaphor  that  has 
slipped  in  perhaps  without  arousing  all  the  implica- 
tions the  term  plant  might  carry  and  does  carry. 

Some  years  ago  my  wife  celebrated  her  birthday 
and  told  her  colored  cook  jocosely:  "Geneva,  I  am 
a  hundred  years  old  to-day."  The  cook's  jaw 
dropped  and  then  she  suddenly  remarked:  "Lord! 
you  don't  look  dat  ole."  That  is  the  way  I  feel 
about  Bloomingdale  Hospital  as  we  see  it  to-day 
pulsating  with  ever-fresh  life  and  ever-fresh  problems  ! 
How  different  from  a  simple  human  being,  after  all ! 
The  heart  and  wisdom  of  many  a  man  and  woman  has 
gone  into  the  perpetuation  of  what  a  few  thoughtful 
men  started  in  1821  and  the  result  is  that  it  is  ever 
renewing  its  youth. 

Many  a  dream  has  been  realized  and  many  a  dream 
has  given  way  to  another.  Here  and  there  the  past 
may  make  itself  felt  too  much.  But  the  spirit  and 


A    PSYCHIATRIC   MILESTONE 

its  growth  show  in  recruiting  ever-new  lives  to  meet 
the  present  day  and  the  days  to  come,  and  this  all 
the  more  so  if  we  can  show  the  younger  generation 
that  every  effort  is  likely  to  have  its  reasonable  di- 
rect support.  We  all  want  a  man  like  Dr.  William 
L.  Russell  to  have  the  fullest  opportunity  to  bring 
to  its  best  expression  the  rich  and  well-tried  wisdom 
of  over  twenty-five  years  of  devoted  work  in  the 
field.  This  is  no  doubt  a  time  of  stress  when  many 
personal  and  general  sacrifices  may  be  needed  to 
bring  about  the  fruition  and  culmination  of  the 
labors  of  the  present  generation.  Yet  is  it  not  a 
clear  opportunity  and  duty,  so  that  those  who  are 
growing  up  in  the  ranks  to-day  may  really  be  en- 
couraged to  get  a  solid  training,  always  animated 
by  the  conviction  that  one  can  be  sure  of  the  prac- 
tical reward  for  toiling  through  the  many  years  of 
preparation  in  a  psychiatric  career,  whether  it  be  as 
a  physician  or  as  a  nurse  or  as  an  administrator  ? 

I  cannot  help  feeling  as  I  stand  here  that  I  am  in 
a  way  representing  not  only  my  own  sentiments 
and  convictions  but  those  of  our  dear  old  friend 
Hoch.  We  all  wish  that  he  might  be  with  us  to 
express  himself  the  warm  feelings  toward  the  Bloom- 
ingdale  Hospital  and  its  active  representatives,  from 
the  managers  to  the  humblest  workers.  Hoch  in 
his  modesty  could  probably  not  have  been  brought 

[52] 


PSYCHIATRY   AND    LIFE    PROBLEMS 

to  state  fully  and  frankly  his  own  share  in  the  achieve- 
ments of  this  Hospital.  But  I  know  how  much  he 
would  have  liked  to  be  here  to  express  especially 
the  warmth  of  appreciation  we  all  entertain  of  what 
our  friend  William  L.  Russell  means  to  us  and  has 
meant  to  us  all  through  the  nearly  twenty-five  years 
of  our  friendship  and  of  working  together.  We  de- 
light in  seeing  him  bring  to  further  fruition  the  ad- 
mirable work  he  did  at  Willard,  and  later  for  all  the 
State  hospitals;  and  that  which  we  see  him  do  at 
all  times  for  sanity  in  the  progress  of  practical 
psychiatry,  and  now  especially  in  the  guidance  of 
this  institution.  We  delight  in  seeing  his  master 
mind  given  more  and  more  of  a  master's  chance  for 
the  practical  expression  of  his  ideals  and  convictions 
concerning  the  duties  and  opportunities  of  such  a 
hospital  as  Bloomingdale. 

Our  thanks  and  best  wishes  to  those  who  invited 
us  to  stand  here  to-day  at  the  cradle  of  a  second 
century  of  Bloomingdale  Hospital!  It  is  a  note- 
worthy gathering  that  joins  here  in  good  wishes  to 
those  who  have  shaped  this  ever-new  Bloomingdale. 
With  a  tribute  to  our  thoughtful  and  enthusiastic 
friend  in  internal  medicine,  Lewellys  F.  Barker,  to 
our  English  coworker,  Richard  G.  Rows,  to  the 
illustrious  champion  of  French  psychopathology, 
Pierre  Janet,  to  our  friend  and  leader  in  practical 

[53] 


A    PSYCHIATRIC    MILESTONE 

psychiatry,  William  L.  Russell,  to  our  friends  and 
coworkers  of  the  Bloomingdale  staff,  and  especially 
also  to  the  Board  of  Governors  who  shape  the  policy 
and  control  the  finances,  and  exercise  the  leadership 
of  public  opinion,  I  herewith  express  my  sincerest 
thanks  and  best  wishes. 


[54] 


ADDRESS      BY 

DR.    LEWELLYS    F.    BARKER 


The  Chairman : — The  Johns  Hopkins  Medical 
School  lends  us  also  to-day  Dr.  Lewellys  F.  Barker, 
its  Professor  of  Clinical  Medicine.  Dr.  Barker  has 
done  so  much  to  define  and  settle  the  contradictions 
of  mind  and  matter,  and  has  clarified  so  much,  and 
in  fields  so  varied,  as  teacher,  research  worker,  and 
practitioner,  that  we  welcome  this  opportunity  of 
listening  to  his  discussion  of  "THE  IMPORTANCE  OF 
PSYCHIATRY  IN  GENERAL  MEDICAL  PRACTICE." 


DR.  BARKER 

We  have  met  to-day  to  celebrate  the  hundredth 
anniversary  of  the  founding  of  a  hospital  that,  in 
its  simpler  beginnings  and  in  its  evolution  to  the 
complex  and  highly  organized  activities  of  the  pres- 
ent, has  served  an  eminently  practical  purpose  and 
has  played  an  important  role  in  the  development 
of  the  science  and  art  of  psychiatry  in  America. 
I  desire,  as  a  representative  of  general  medicine,  and, 
especially,  of  internal  medicine,  to  add,  on  this  oc- 
casion, my  congratulations  to  those  of  the  spokes- 
men of  other  groups,  and,  at  the  same  time  to  ex- 
press the  hope  that  this  institution,  historically  so 
significant  for  the  century  just  past,  may  maintain 
its  relative  influence  and  reputation  in  the  centuries 
to  come. 

The  interest  taken  in  psychiatry  by  the  general 
practitioner  and  by  the  consulting  internist  has  been 
growing  rapidly  of  late.  Some  of  the  reasons  for 
this  growth  of  interest  and  heightening  of  apprecia- 
tion I  have  drawn  attention  to  on  an  earlier  oc- 
casion.* Psychiatry  as  a  whole  was  for  a  long  time 

*  In  an  address  at  the  seventieth  annual  meeting  of  the  American 
Medico- Psychological  Association,  1914,  entitled  "The  Relations  of 
Internal  Medicine  to  Psychiatry." 

[59} 


A    PSYCHIATRIC    MILESTONE 

as  widely  separated  from  general  medicine  as  pen- 
ology is  to-day,  and  for  similar  reasons.  It  was  a 
long  time  before  persons  that  manifested  extraordi- 
nary abnormalities  of  thought,  feeling,  and  behavior 
were  regarded  as  deserving  medical  study  and  care, 
and  even  when  a  humanitarian  movement  led  to 
their  transfer  from  straight-jackets,  chains,  and 
prison  cells  to  "asylums  for  the  insane,"  these  insti- 
tutions were,  for  practical  reasons,  so  divorced  from 
the  homes  of  the  people  and  from  general  hospitals 
that  psychiatry  had,  and  could  at  the  time  have, 
but  little  intercourse  with  general  medicine  or  with 
general  society.  Mental  disorders  were  moral  and 
legal  problems  rather  than  biological,  social,  and 
medical  problems.  Their  genesis  was  wholly  mis- 
understood, and  legal,  medical,  social,  religious,  and 
philosophic  prejudices  went  far  toward  preventing 
any  rational  scientific  mode  of  approach  to  the  ques- 
tions involved  or  any  formulation  of  investigative 
procedures  that  promised  to  be  fruitful.  Even  to- 
day the  same  prejudices  are  all  too  inhibitory;  but 
thanks  to  the  unprecedented  development  of  the 
natural  sciences  during  the  period  since  this  hospital 
was  founded,  we  are  witnessing,  in  our  time,  a  rapid 
transformation  of  thought  and  opinion  concerning 
both  the  normal  and  the  disordered  mind,  a  trans- 
formation that  is  reaching  all  circles  of  human  be- 

[60] 


PSYCHIATRY   IN   GENERAL    MEDICINE 

ings,  bidding  fair  to  compel  the  strongholds  of  tradi- 
tion and  prejudice  to  relax,  and  inviting  the  whole- 
hearted co-operation  of  workers  in  all  fields  in  a 
common  task  of  overcoming  some  of  the  greatest 
difficulties  by  which  civilization  and  human  progress 
are  confronted.  And  though  the  brunt  of  this  task 
is  borne  and  must  be  borne  by  the  shoulders  of  medi- 
cal men,  physicians  assume  the  burden  cheerfully, 
now  that  they  know  that  they  can  count  upon  the 
intelligent  support  and  the  cordial  sympathy  of  an 
ever-enlarging  extra-medical  aggregate.  No  better 
illustration  could  be  given,  perhaps,  of  the  change  in 
the  status  of  psychiatry  in  this  country  and  in  the 
world  than  the  contents  of  the  programme  of  our 
meeting  to-day  at  which  a  distinguished  investigator 
from  London  tells  us  of  the  biological  significance  of 
mental  disorders,  an  eminent  authority  from  Paris 
explains  the  relationship  between  certain  diseases  of 
the  nervous  system  and  these  disorders,  and  a  lead- 
ing psychiatrist  of  this  country  speaks  upon  the  con- 
tributions of  psychiatry  to  the  understanding  of  the 
problems  of  life.  Psychiatry,  like  each  of  the  other 
branches  of  medicine,  has  come  to  be  recognized  as 
one  of  the  subdivisions  of  the  great  science  of  biology, 
free  to  make  use  of  the  scientific  method,  in  duty 
bound  to  diffuse  the  knowledge  that  it  gains,  and 
privileged  to  contribute  abundantly  to  the  lessening 

[61] 


A    PSYCHIATRIC    MILESTONE 

of  human  suffering  and  the  enhancement  of  human 
joys.  General  practitioners  of  medicine  and  medi- 
cal specialists — at  least  the  more  enlightened  of 
them — welcome  the  developing  science  of  psychiatry, 
are  eager  to  hasten  its  progress,  and  will  gladly 
share  in  applying  its  discoveries  to  the  early  diagnosis, 
the  cure,  and  the  prevention  of  disease. 

That  the  majority  of  medical  and  surgical  special- 
ists and  even  most  of  the  widely  experienced  general 
practitioners,  though  constantly  coming  in  contact 
with  major  and  minor  psychic  disturbances,  are, 
however,  still  far  from  realizing  the  full  meaning 
and  value  of  the  principles  and  technic  of  modern 
psychology  and  of  the  newer  psychiatry  must,  I 
fear,  be  frankly  admitted.*  But  dare  we  blame  these 
practitioners  for  their  ignorance  of,  apathy  regarding, 
and  even  antipathy  to,  the  psychic  and  especially 
the  psychotic  manifestations  of  their  patients  ? 
Ought  we  not  rather  to  try  to  understand  the  reasons 
for  this  ignorance,  this  apathy,  and  this  aversion, 
all  three  of  which  seem  astonishing  to  many  of  our 
well-trained  psychologists  and  psychopathologists  ? 
Are  there  not  definite  conditions  that  explain  and  at 
least  partially  excuse  the  defects  in  knowledge  and 
interest  and  the  errors  in  attitude  manifested  by 

*  Cf.  Polon  (A.)  "The  Relation  of  the  General  Practitioner  to  the 
Neurotic  Patient,"  Mental  Hygiene,  New  York,  1920,  IV,  670-678. 

[62] 


PSYCHIATRY   IN   GENERAL    MEDICINE 

those  whom  we  would  be  glad  to  see  cognizant 
and  enthusiastically  participant  ?  Psychiatrists,  who 
have  taught  us  to  understand  and  rescue  various 
types  of  "sinners"  and  "social  offenders"  will,  I 
feel  sure,  avoid  any  moralistic  attitude  when  dis- 
cussing the  shortcomings  of  their  brethren  in  the 
general  medical  profession,  and  will,  instead,  seek 
to  discover  and  to  remove  their  causes. 

As  an  internist  who  values  highly  the  gifts  that 
modern  psychology  and  psychiatry  have  been  mak- 
ing to  medicine,  I  have  given  some  thought  to  the 
conditions  and  causes  that  may  be  responsible  for 
these  professional  delinquencies  that  you  deplore. 
Though  this  is  not  the  time  nor  the  place  fully  to  dis- 
cuss them,  the  mere  mention  of  some  of  the  causes 
and  conditions  will,  perhaps,  contribute  to  compre- 
hension and  pardon,  and  may  serve  to  stimulate  us 
all  to  livelier  corrective  activity.  Let  me  enumerate 
some  of  them : 

(1)  A  social  stigma  still  attaches,  despite  all  our 
efforts  to  abolish  it,  to  mental  disorders  and  has,  to 
a  certain  extent,  been  transferred  to  those  that  study 
and  treat  patients  manifesting  these  disorders. 

(2)  The  organization  of  our  general  education  is 
very  defective  since  it  fails  to  make  clear  to  each 
student  man's  place  in  the  universe  and  any  orderly 
view  of  the  world  and  man;  it  fails  adequately  to 


A    PSYCHIATRIC    MILESTONE 

enlighten  the  student  regarding  the  processes  of  life 
as  adaptations  of  organisms  to  their  environment, 
man,  himself,  being  such  an  organism  reacting  physi- 
cally and  psychically  to  his  surroundings  in  ways 
either  favorable  or  unfavorable  to  his  own  preserva- 
tion and  that  of  his  species;  it  fails  to  teach  the 
student  that  the  human  organism  represents  a  bun- 
dle of  instincts  each  with  its  knowing,  its  feeling, 
and  its  striving  component,  that  what  we  call 
"knowledge"  and  what  we  call  "character"  are 
gradual  developments  in  each  person,  and  that  if  we 
know  how  they  have  developed  in  a  particular  per- 
son we  possess  clues  to  the  way  that  person  will 
react  under  a  given  stimulus,  that  is  to  say,  what  he 
will  think,  how  he  will  feel,  and  how  he  will  act;  and 
it  fails,  again,  properly  to  instruct  students  regarding 
the  interrelationships  of  members  of  different  social 
groups  (familial,  civic,  economic,  occupational,  ethi- 
cal, national,  racial,  etc.) ;  in  other  words,  our  general 
educational  organization  is  as  yet  far  from  successful 
in  inculcating  philosophical,  biological,  psychological, 
and  sociological  conceptions  that  are  adequate  sym- 
bols of  reality. 

(3)  Though  our  medical  schools  have  made  phe- 
nomenal advances  in  the  organization  and  equip- 
ment of  their  institutes  and  in  provision  for  teach- 
ing and  research  in  a  large  number  of  preclinical 

[64] 


PSYCHIATRY    IN   GENERAL    MEDICINE 

and  clinical  sciences,  they  have  up  to  now  almost 
wholly  ignored  normal  psychology,  psychiatry,  and 
mental  hygiene.  The  majority  of  the  professors 
in  these  schools  are  so  absorbed  by  the  morphologi- 
cal, physical,  and  chemical  aspects  of  their  subjects, 
that  students  rarely  get  from  them  any  inkling  of 
the  psychobtological  aspect,  any  adequate  knowledge 
of  human  motives,  or  any  satisfactory  data  regard- 
ing human  behavior,  normal  or  abnormal.*  It  is 
only  recently  and  only  in  a  few  schools  that  psy- 
chiatric clinics  have  been  established  as  parts  of  the 
teaching  hospitals,  that  medical  students  have  been 
able  to  come  into  direct  contact  over  an  appreciable 
period  of  time  with  the  objects  of  psychiatric  study, 
that  the  psychic  manifestations  of  patients  have 
received  any  direct  and  particular  attention  in  the 
general  medical  and  surgical  wards,  and  that  there 
has  been  any  free  and  constant  reciprocal  exchange 
of  thought  and  opinion  between  students  of  the 
somatic  on  the  one  hand  and  students  of  the  psychic 
on  the  other. 

(4)  The  language  of  the  psychiatrist  is  unique 
and  formidable.  The  names  he  has  applied  to  mo- 
tives and  impulses,  to  symptoms  and  syndromes,  are 

*  Cf.  Paton  (S.)  Human  Behavior  in  Relation  to  the  Study  of 
Educational,  Social,  and  Ethical  Problems.  New  York,  1921. 
Charles  Scribner's  Sons,  p.  465. 

[65] 


A    PSYCHIATRIC   MILESTONE 

foreign  to  the  tongue  of  the  general  practitioner  who 
is  so  awed  by  them  that  he  withdraws  from  them  and 
remains  humbly  reticent  in  a  state  of  enomatophobia; 
or,  if  he  be  more  tough-minded,  he  may  be  amused 
by,  or  contemptuous  of,  what  he  refers  to  as  "psy- 
chiatric jargon"  or  " pseudoscientific  gibberish." 
There  is,  furthermore,  a  dearth  of  concise,  authori- 
tative, well-written  text-books  on  psychiatry,  and 
the  general  medical  journals  rarely  print  psychiatric 
papers  designed  to  interest  the  average  practitioner. 
The  most  widely  diffused  psychiatric  reports  of  our 
time  are  the  sensational  news  items  of  the  daily 
press. 

(5)  The   overemphasis   of  psychogenetic   factors 
to  the  apparent  neglect  of  important  somatogenic 
factors  by  some  psychiatrists  has  tended  to  arouse 
suspicion  regarding  the  soundness  of  the  opinions 
and  methods  of  psychiatric  workers  in  the  minds  of 
men  thoroughly  imbued  with  mechanistic  concep- 
tions and  impressed  with  the  results  of  medical  re- 
searches based  upon  them.     The  ardor  of  the  psy- 
choanalysts, also,  though  in  part  doubtless  justified 
by  experience,  has,  it  is  to  be  feared,  excited  a  cer- 
tain amount  of  antipathy  among  the  uninitiated. 

(6)  The  fears  of  insanity  prevalent   among  the 
laity  and  the  repugnance  of  patients  to  any  idea  that 
they    may    be    "psychotic"    or    " psychoneurotic " 

[66] 


PSYCHIATRY    IN   GENERAL   MEDICINE 

(words  that,  in  their  opinion,  refer  to  "imaginary 
symptoms/'  or  to  symptoms  that  they  could  abolish 
if  they  would  but  "buck  up"  and  exert  their  "wills") 
undoubtedly  exert  a  reflex  influence  upon  practi- 
tioners who  put  the  "soft  pedal"  on  the  psycho- 
biological  reactions  and  "pull  out  the  stop"  that 
amplifies  the  significance  of  any  abnormal  physical 
findings. 

(7)  Psychotherapy,  to  the  mind  of  the  average 
medical  practitioner,  is  (or  has  been)  something 
mysterious  or  occult.  He  uses  much  psychotherapy 
himself  but  it  is  nearly  always  applied  unconsciously 
and  indirectly  through  some  form  of  physical  or 
chemical  therapy  that  he  believes  will  cure.  He  is 
sually  quite  devoid  of  insight  into  the  effect  of  his 
own  expressed  beliefs  and  bodily  attitudes  upon  the 
adjusting  mechanisms  of  his  patients.  Conscious 
and  direct  psychotherapy  is  left  by  the  average 
practitioner  to  New  Thoughters,  Christian  Scien- 
tists, quacks,  and  charlatans.  If  he  were  to  use 
psychotherapy  consciously  and  were  to  receive  a 
professional  fee  for  it  he  would  feel  that  he  was  being 
paid  for  a  value  that  the  patient  had  not  received. 
A  highly  respected  colleague  once  privately  criticised 
a  paper  of  mine  (read  before  the  Association  of 
American  Physicians)  on  the  importance  of  psy- 
chotherapy. "What  you  said  is  true,"  he  remarked; 


A    PSYCHIATRIC    MILESTONE 

"we  all  use  psychotherapy  but  we  are  a  little  ashamed 
of  it;  and  it  is  better  not  to  talk  about  it."  Even  he 
did  not  realize  that  every  psychotherapy  is  also  a 
physical  therapy. 

(8)  The  rise  of  specialism,  through  division  of 
labor  and  intensification  of  interests  restricted  to 
limited  fields,  in  practical  medicine,  the  necessary 
result  and  to  a  large  extent  also  a  cause  of  the 
rapid  growth  of  knowledge  and  technic  has  brought 
with  it  many  advantages,  but  also  some  special 
difficulties,  among  them  (a)  the  impossibility  any 
longer  of  any  single  practitioner,  unaided,  to  study 
and  treat  a  patient  as  well  as  he  can  be  studied  and 
treated  by  a  co-ordinated  group  whose  special  ana- 
lytical studies  in  single  domains  are  adequately 
synthesized  by  a  competent  integrator,  and  (b)  in 
the  absence  of  such  group  work,  the  tendency  to 
one-sided  study,  partial  diagnosis,  and  incomplete 
and  unsatisfactory  therapy.  Through  the  rise  df 
specialism,  it  is  true,  psychiatry  itself  has  arisen  and 
the  psychiatrist,  like  the  skilled  integrating  internist, 
is  interested  in  the  synthesis  of  the  findings  in  all 
domains,  for  only  through  such  synthetic  studies, 
such  integration  of  the  functional  activities  of  the 
whole  organism,  is  it  possible  to  gain  a  global  view 
of  the  patient  as  a  person,  to  make  a  complete  so- 
matic, psychic,  and  social  diagnosis,  and  to  plan  a 

[68] 


PSYCHIATRY    IN    GENERAL    MEDICINE 

regimen  for  him  that  will  ensure  the  best  adjust- 
ment possible  of  his  internal  and  external  relation- 
ships.* 

Working  in  a  diagnostic  group  myself  as  an  inte- 
grating internist,  I  have  been  much  helped  by  the 
reports  of  personality  studies  made  by  skilful  psy- 
chiatrists; these  are  linked  with  the  special  reports 
on  the  several  bodily  domains  (cardiovascular,  respir- 
atory, haemic,  dental,  digestive,  urogenital,  loco- 
motor,  neural,  metabolic,  and  endocrine)  in  order 
finally  to  arrive  at  an  adequately  co-ordinated  and 
(subordinated)  total  diagnosis  from  which  the  clues 
for  an  appropriate  therapeutic  regimen  can  safely 
be  drawn.  If  group  practice  is  to  grow  and  be  suc- 
cessful in  this  country,  as  I  think  likely,  groups  must 
see  to  it  that  psychiatry,  as  well  as  the  other  medical 
and  surgical  specialties,  is  properly  represented  in 
their  make-up. f  From  now  on,  too,  general  prac- 

*  Cf.  Meyer  (A.),  "Progress  in  Teaching  Psychiatry,"  Journal 
A.  M.  A.,  Chicago,  1917,  LXIX,  861-863;  see  also  his,  "Objective 
Psychobiology,  or  Psychobiology  with  Subordination  of  the  Medically 
Useless  Contrast  of  Medical  and  Physical,"  Journal  A.  M.  A.,  Chicago, 
1915,  LXV,  860-863;  and,  "Aims  and  Meanings  of  Psychiatric  Diag- 
nosis," Am.  Journal  of  Insanity,  Baltimore,  1917,  LXXIV,  163-168. 

f  Cf.  "The  General  Diagnostic  Survey  Made  by  the  Internist  Co- 
operating with  Groups  of  Medical  and  Surgical  Specialists,"  New  York 
Medical  Journal,  1918,  489,  538,  577;  also,  "The  Rationale  of  Clinical 
Diagnosis,"  Oxford  Medicine,  1920,  vol.  I,  619-684;  also,  "Group 
Diagnosis  and  Group  Therapy,"  Journal  Iowa  State  Medical  Society, 
113-121,  Des  Moines,  1921. 

[69] 


A    PSYCHIATRIC    MILESTONE 

titioners  should,  as  Southard  emphasized,  be  urged 
to  be  at  least  as  familiar  with  the  general  principles 
and  methods  of  the  psychiatrist  as  they  are  with 
those  of  the  gynecologist,  the  dermatologist,  and  the 
paediatrist.*  Well  organized  group-diagnosis  and 
general  will  then  help  to  counteract  the  inhibiting 
influence  of  earlier  isolated  specialism  upon  the  ap- 
preciation of  psychiatry. 

This  enumeration  of  some  of  the  causes  of  the 
ignorance  and  apathy  (existent  hitherto)  in  the  gen- 
eral profession  regarding  psychiatry  may  perhaps 
suffice  as  explanation.  These  causes  are,  fortunately, 
rapidly  being  removed.  We  are  entering  upon  an 
era  in  which  psychiatry  will  be  recognized  as  one  of 
the  most  important  specialties  in  medicine,  an  era 
that  will  demand  alliance  and  close  communion 
among  psychiatrists,  internists,  and  the  representa- 
tives of  the  various  medical  and  surgical  specialties. 

The  internist  and  the  psychiatrist  will  ever  have 
a  common  interest  in  the  obscure  problems  of  etiology 
and  pathogenesis  of  diseases  and  anomalies  that  are 
accompanied  by  abnormalities  of  thought,  feeling, 
and  behavior.  Progress  in  this  direction  is  bound  to 
be  slow  for  the  studies  are  exceptionally  complex  and 

*  Cf.  Southard  (E.  E.),  "Insanity  Versus  Mental  Disease";  the  Duty 
of  the  General  Practitioner  in  Psychiatric  Diagnosis,  Journal  Ameri- 
can Medical  Association,  LXXI,  1259-1261,  Chicago,  1918. 

[70] 


PSYCHIATRY   IN   GENERAL    MEDICINE 

there  are  many  impediments  to  be  removed.  Though 
the  problems  are  deep  and  difficult,  they  are  doubt- 
less soluble  by  the  mind  of  man,  and  they  exert  an 
uncommon  fascination  upon  those  who  visualize 
them.  Causes  may  be  internal  or  external,  and  are 
often  a  combination  of  both.  The  tracing  of  the 
direct  and  indirect  relationships  between  these 
causes  and  the  abnormal  cerebral  functioning  upon 
which  the  disturbances  of  psychobiological  adjust- 
ment seem  to  depend  is  the  task  of  pathogenesis. 
The  internist  who  has  studied  the  infantile  cere- 
bropathies  with  their  resulting  imbecilities,  syphilis 
followed  by  general  paresis,  typhoid  fever  and  its 
toxic  delirium,  chronic  alcoholism  with  its  character- 
istic psychoses,  cerebral  thrombosis  with  its  aphasias, 
agnosias,  and  apraxias,  thalmic  syndromes  due  to 
vascular  lesions  with  their  unilateral  pathological 
feeling-tone,  frontal-lobe  tumors  with  joke-making, 
uncus  tumors  with  hallucinations  of  taste  and  smell, 
lethargic  encephalitis  with  its  disturbance  of  the 
general  consciousness  and  its  psychoneurotic  se- 
quelae (lesions  in  the  globus  pallidus  and  their  motor 
consequences),  pulmonary  tuberculosis  with  its  eu- 
phoria, and  endocrinopathies  like  myxoedema  and 
exophthalmic  goitre  with  their  pathological  mental 
states,  is  encouraged  to  proceed  with  his  clinical- 
pathological-etiological  studies  in  full  assurance  that 


A    PSYCHIATRIC   MILESTONE 

they  will  steadily  contribute  to  advances  in  psy- 
chiatry. The  eclectic  psychiatrist  who  is  examining 
mental  symptoms  and  symptom-complexes  ever 
more  critically,  who  is  seeking  for  parallel  distur- 
bances in  physiological  processes  and  who  considers 
both  psychogenesis  and  somatogenesis  in  attempting 
to  account  for  psychobiological  maladjustments  will 
welcome,  we  can  feel  sure,  any  help  that  internal 
medicine  and  general  and  special  pathology  can 
yield. 

These  studies  in  pathogenesis  and  etiology  are 
fundamentally  necessary  for  the  development  of  a 
rational  therapy  and  prophylaxis.  Already  much 
that  is  of  applicable  value  in  practice  has  been 
achieved.  The  internist  shares  with  the  psychiatrist 
the  desire  that  knowledge  of  the  facts  regarding  care, 
cure,  and  prevention  of  mental  disorders  may  be- 
come widely  disseminated  among  medical  men  and 
at  least  to  some  extent  among  the  laity.  Experts 
in  psychiatry  firmly  believe  that  at  least  half  of  the 
mental  disturbances  now  prevalent  could  have  been 
prevented,  if,  during  the  childhood  and  adolescence 
of  those  afflicted,  the  facts  and  principles  of  existing 
knowledge  and  the  practical  resources  now  available 
could  have  been  applied. 

We  have  recently  had  an  excellent  illustration  of 
the  benefits  of  applied  psychiatry  in  the  remarkable 

[72] 


PSYCHIATRY    IN   GENERAL   MEDICINE 

results  achieved  during  the  great  war  through  the 
activities  of  the  head  of  the  neuropsychiatric 
division  of  the  Surgeon  General's  office  and  his  staff  * 
and  those  of  the  senior  consultant  in  neuropsy- 
chiatry  and  his  divisional  associates  in  the  Ameri- 
can Expeditionary  Force.  In  no  other  body  of  re- 
cruits and  in  no  other  army  than  the  American  was  a 
comparable  success  arrived  at,  and  the  credit  for 
this  is  due  to  American  applied  psychiatry  and  its 
wisely  chosen  official  representatives. 

The  active  campaign  for  the  preservation  of  the 
mental  health  of  our  people  and  for  a  better  under- 
standing and  care  of  persons  presenting  abnormal 
mental  symptoms  carried  on  during  the  past  decade 
by  the  National  Committee  for  Mental  Hygiene 
marks  a  new  epoch  in  preventive  medicine.t 

The  prevention  of  at  least  a  large  proportion  of 
abnormal  mental  states  through  the  timely  applica- 

*  Cf.  Bailey  (P.),  "The  Applicability  of  Findings  of  Neuro-psy- 
chiatric  Examinations  in  the  Army  to  Civil  Problems,"  Mental  Hy- 
giene, New  York,  1920,  IV,  301;  also  "War  and  Mental  Diseases," 
Am.  J.  Pub.  Health,  IX,  i,  Boston,  1919. 

f  Cf.  Salmon  (T.  W.),  "War  Neuroses  and  Their  Lesson,"  New  York 
Medical  Journal,  CIX,  993,  1919;  also,  "The  Future  of  Psychiatry  in 
the  Army,"  Mil.  Surgeon,  XLVII,  200,  Washington,  1920. 

Cf.  "Origin,  Objects,  and  Plans  of  the  National  Committee  for 
Mental  Hygiene"  (Publication  No.  i,  of  the  National  Committee, 
New  York  City) ;  and,  "  Some  Phases  of  the  Mental  Hygiene  Movement 
and  the  Scope  of  the  Work  of  the  National  Committee  for  Mental 
Hygiene,"  in  Trans.,  XV,  Internat.  Congr.  for  Hygiene  and  Demog- 
raphy, III,  468-476,  (1912),  Washington  1913. 

[73] 


A    PSYCHIATRIC    MILESTONE 

tion  of  the  principles  of  mental  hygiene  is  now  recog- 
nized as  a  practically  realizable  ideal.  Many  im- 
portant reforms  are  now  in  process  throughout  the 
United  States,  no  small  part  of  them  directly  attrib- 
utable to  the  active  efforts  of  our  leading  psy- 
chiatrists and  to  our  National  Committe's  work. 
The  old  "asylums"  are  being  changed  into  "hospi- 
tals." Psychiatric  clinics  are  becoming  attached 
to  teaching  hospitals  and  psychiatric  instruction  in 
the  medical  schools  is  being  vastly  improved.  The 
mental  symptoms  of  disease  now  receive  attention 
in  hospitals  and  in  private  practice  and  at  a  much 
earlier  stage  than  formerly.  Even  the  courts,  the 
prisons,  and  the  reformatories  are  awakening  to  the 
importance  of  scientific  psychiatry;  before  long 
penology  may  be  brought  more  into  accord  with  our 
newer  and  juster  conceptions  of  the  nature  and  ori- 
gin of  crime,  dependency,  and  delinquency.  That 
schools  of  hygiene  and  the  public  health  services 
must  soon  fall  into  line  and  consider  mental  hygiene 
seriously  is  obvious.  The  objection  sometimes  made 
that  the  practical  problems  are  too  vague,  not  suffi- 
ciently concrete,  to  justify  attack  by  public  health 
officials  is  no  longer  valid.  In  no  direction,  proba- 
bly, could  money  and  energy  be  more  profitably 
spent  during  the  period  just  ahead  than  in  the  sup- 
port of  a  widely  organized  campaign  for  Mental 

[74] 


PSYCHIATRY    IN   GENERAL    MEDICINE 

Hygiene.*  Psychiatrists  can  count  upon  internists 
and  general  practitioners  to  aid  them  in  educating 
the  public  regarding  the  nature  and  desirability  of 
this  campaign. 

Man  is  now  consciously  participating  in  the  direc- 
tion of  his  own  evolution.  To  cite  England's  poet 
laureate,  who,  you  will  recall,  is  a  physician:  "The 
proper  work  of  his  (man's)  mind  is  to  interpret  the 
world  according  to  his  higher  nature,  and  to  conquer 
the  material  aspects  of  the  world  so  as  to  bring 
them  into  subjection  to  the  spirit." 

*Cf.  Russell  (W.  L.)  "Community  Responsibilities  in  the  Treat- 
ment of  Mental  Disorders."  Canad.  J.  Ment.  Hygiene,  1919, 

I  155  -• 

Hincks  (C.  M.),  "Mental  Hygiene  and  Departments  of  Health," 
Am.  J.  Pub.  Health,  Boston,  IX,  352,  1919;  Haines  (T.  H.),  "The 
Mental  Hygiene  Requirements  of  a  Community:  Suggestions  Based 
upon  a  Personal  Survey,"  Mental  Hygiene,  IV,  920-931,  New  York, 
1920. 

Beers  (C.  W.),  "Organized  Work  in  Mental  Hygiene,"  Mental 
Hygiene,  567,  New  York,  1917,  also,  Williams  (F.  E.)>  "Progress  in 
Mental  Hygiene,"  Modern  Hospital,  XIV,  197,  Chicago,  1920. 


[75] 


The  Chairman :  We  had  hoped  to  receive  to-day 
the  greetings  of  our  sole  elder  sister  among  Ameri- 
can institutions,  the  Pennsylvania  Hospital,  of 
Philadelphia,  which  since  its  foundation  in  1751 
has  pursued  a  career  much  like  our  own,  treating 
mental  cases  in  the  general  hospital  from  the  very 
beginning,  and  since  1841  maintaining  a  separate 
department  for  mental  diseases  in  West  Philadelphia. 
Dr.  Owen  Copp,  the  masterly  physician-in-chief 
and  administrator  of  that  department,  was  to  have 
been  here,  but  unfortunately  has  been  detained. 
Our  morning  exercises  having  come  to  an  end,  Dr. 
Russell  asks  me  to  say  that  your  inspection  of  the 
occupational  buildings  and  other  departments  of 
the  Hospital  is  cordially  invited;  a  pageant  illus- 
trative of  the  origin  and  aspirations  of  the  Hos- 
pital will  be  given  on  the  adjoining  lawn;  and  that 
after  the  pageant  our  guests  are  desired  to  return  to 
the  Assembly  Hall,  where  we  shall  have  the  privi- 
lege of  listening  to  addresses  by  Dr.  Richard  G. 
Rows,  of  London,  and  Dr.  Pierre  Janet,  of  Paris, 
who  have  come  across  the  Atlantic  especially  to 
take  part  in  this  anniversary  celebration. 


ADDRESS      BY 

DR.    GEORGE    D.    STEWART 


AFTERNOON  SESSION 

The  Chairman:  For  the  first  seventy-five  years 
of  its  existence  the  New  York  Hospital  was  the 
nearest  approach  to  an  academy  of  medicine  that 
the  city  possessed.  When  the  now  famous  New 
York  Academy  of  Medicine  was  established  in  1847, 
a  friendly  and  cordial  co-operation  between  the 
two  institutions  arose,  and  while  the  activity  of 
this  co-operation  is  not  as  pronounced  as  it  was,  we 
still  cherish  in  our  hearts  a  warm  regard  for  that 
ancient  ally  in  the  cause  of  humanity.  Its  Presi- 
dent, Dr.  George  D.  Stewart,  the  distinguished 
surgeon,  has  come  to  extend  the  greetings  of  the 
medical  profession  of  New  York  City. 


DR.  STEWART 

The  emotions  that  attend  the  birthday  celebra- 
tions of  an  individual  are  often  a  mixture  of  joy 
and  sadness,  of  laughter  and  of  tears.  In  warm 
and  imaginative  youth  there  is  no  sadness  and  there 
are  no  tears,  because  that  cognizance  of  the  com- 
mon end  which  is  woven  into  the  very  warp  and 
woof  of  existence  is  then  buried  deep  in  our  sub- 
conscious natures,  or  if  it  impresses  itself  at  all,  is 
too  volatile  and  fleeting  to  be  remembered.  But 
as  the  years  fall  away  and  there  is  one  less  spring  to 
flower  and  green,  the  serious  man  "tangled  for  the 
present  in  some  parcels  of  fibrin,  albumin,  and 
phosphates"  looks  forward  and  backward  and  takes 
in  both  this  world  and  the  next.  In  the  case  of 
institutions,  however,  the  sadness  and  the  tears  do 
not  obtain — for  a  century  of  anniversaries  may 
merely  mean  dignified  maturity,  as  in  the  case  of 
Bloomingdale,  with  no  hint  of  the  senility  and  decay 
that  must  come  to  the  individual  who  has  lived  so 
long.  This  institution  was  founded  one  hundred 
years  ago  to-day;  the  parent,  the  New  York  Hos- 
pital, has  a  longer  history.  Bloomingdale,  as  a 

[83] 


A    PSYCHIATRIC    MILESTONE 

separate  and  independent  concern,  had  its  birthday 
a  century  ago. 

It  is  curious  to  let  the  mind  travel  back,  and  con- 
sider what  was  happening  about  that  time.  Just 
two  years  before  the  news  had  flashed  on  the  philo- 
sophical and  scientific  world  that  Oersted,  a  Danish 
philosopher,  had  caused  a  deflection  of  the  magnetic 
needle  by  the  passage  near  it  of  an  electric  current. 
The  relation  between  the  two  forces  was  then  and 
there  confirmed  by  separate  observations  all  over 
the  civilized  world.  This  discovery  probably  cre- 
ated more  interest  at  that  time  than  Professor 
Einstein's  recent  announcement  which,  if  accepted, 
may  be  so  disturbing  to  the  principia  of  Newton 
and  to  our  ideas  of  time  and  space.  There  can  be 
no  doubt  that  the  practical  significance  of  Oersted's 
experiment  was  much  more  widely  appreciated  than 
the  theory  of  Einstein,  for  an  understanding  of  the 
latter  is  confined,  we  are  told,  to  not  many  more 
men  than  was  necessary  to  save  Sodom  and  Gomor- 
rah. Its  immense  practical  significance,  however, 
could  have  been  foreseen  by  no  man,  no  matter  with 
what  vision  endowed.  Just  two  years  prior  to  the 
founding  of  this  institution  the  first  steamboat  had 
crossed  the  Atlantic  and  in  the  same  year  that  great 
conqueror,  who  had  so  disturbed  the  peace  of  the 
world  which  was  even  then  as  now  slowly  recovering 


GREETINGS    FROM    THE    PROFESSION 

from  the  ravages  of  war,  breathed  his  last  in  Saint 
Helena,  yielding  to  death  as  utterly  as  the  poorest  hind. 

In  1815,  Bedlam  Hospital  in  South  London  was 
converted  into  an  asylum  for  the  insane  who  were  at 
the  time  called  "lunatics."  The  name  Bedlam  is  a 
corruption  of  the  Hebrew  "Bethlehem" — meaning 
the  House  of  Bread — and  while  the  name  popularly 
came  to  signify  a  noisy  place  it  was  the  beginning  of 
really  scientific  treatment  for  the  tragically  afflicted 
insane.  While  the  treatment  of  the  insane  in  Europe 
was  being  steadily  raised  to  a  higher  plane  of  effi- 
ciency, America  has  also  reason  to  be  proud  of  her 
record  in  this  respect.  During  all  the  years  that 
have  followed,  Bloomingdale  has  been  an  important 
factor  in  the  medical  world  of  New  York. 

There  are  two  phases  of  its  existence  which  might 
be  emphasized — first,  it  was  founded  by  physicians; 
even  then  and,  of  course,  long  before  doctors  had 
proven  that  they  were  in  the  forefront  in  the  pro- 
motion of  humanitarian  activities.  Medicine  has 
always  carried  on  its  banners  an  inscription  to  the 
Brotherhood  of  Man.  It  is  worthy  of  note  that 
when  Pinel  and  Tuke  had  begun  to  regard  mental 
aberration  as  a  disease  and  to  provide  scientific  hos- 
pital treatment  therefor,  American  physicians,  pre- 
pared by  study  and  experimentation,  were  ready  to 
accept  and  apply  the  new  teachings. 

[85] 


A    PSYCHIATRIC    MILESTONE 

A  second  phase  of  great  importance  is  that  insti- 
tutions like  Bloomingdale  have  promoted  the  study 
of  psychology  far  more  than  any  other  factor,  par- 
ticularly because  in  them  the  personality  stripped 
of  some  of  its  intricacies,  the  diseased  personality, 
permits  analysis,  which  the  normal  complex  has  so 
long  defied.  That  it  is  high  time  that  mankind  was 
undertaking  this  knowledge  of  himself  is  particularly 
emphasized  by  the  unrest  and  aberrance  of  human 
behavior  now  startling  and  disturbing  the  whole 
world.  If  mankind  does  not  take  up  this  self  study 
as  Trotter  has  said,  Nature  may  tire  of  her  experi- 
ment man,  that  complex  multicellular  gregarious 
animal  who  is  unable  to  protect  himself  even  from 
a  simple  unicellular  organism,  and  may  sweep  him 
from  her  work-table  to  make  room  for  one  more 
effort  of  her  tireless  and  patient  curiosity.  Psy- 
chology should  be  taught  to  every  doctor  and  to 
every  lettered  man. 

Digressing  for  a  moment,  to  every  one  capable 
of  understanding  it,  there  should  be  imparted  a 
knowledge  of  that  simple  economic  law  announced 
from  the  Garden  of  Eden  after  the  grounds  had 
been  cleared  and  the  gates  closed:  "By  the  sweat  of 
thy  brow  thou  shalt  earn  thy  bread."  The  economic 
phase  indeed  constitutes  a  highly  important  aspect 
of  modern  psychology,  for  abnormal  elements  are 

[86] 


GREETINGS  FROM  THE  PROFESSION 

antisocial,  and  from  pickpockets  to  anarchists  flour- 
ish on  the  soil  of  pauperism.  The  key-note  of  the 
future  is  responsibility.  To  the  educated  and  en- 
lightened man  who  still  asks,  "Am  I  my  brother's 
keeper?"  Cain  has  bequeathed  a  drop  of  his  frat- 
ricidal blood;  and  he  who  spurns  to  do  his  share  of 
the  world's  work,  electing  instead  to  fall  a  burden 
upon  the  community,  deserves  the  fate  of  the  barren 
fig-tree. 

However,  amidst  the  social  unrest,  buffeted  and 
perplexed  by  the  cross  currents  of  our  time,  we 
should  not  be  pessimistic  but  should  look  forward 
with  courage,  parting  reluctantly  with  whatever  of 
good  the  past  contained  and  living  hopefully  in  the 
present.  As  Ellis  says:  "The  present  is  in  every  age 
merely  the  shifting  point  at  which  past  and  future 
meet,  and  we  can  have  no  quarrel  with  either. 
There  can  be  no  world  without  traditions;  neither 
can  there  be  any  life  without  movement.  As 
Heraclitus  knew  at  the  outset  of  modern  philosophy, 
we  cannot  bathe  twice  in  the  same  stream,  though 
as  we  know  to-day,  the  stream  still  flows  in  an  un- 
ending circle.  There  is  never  a  moment  when  the 
new  dawn  is  not  breaking  over  the  earth,  and  never 
a  moment  when  the  sunset  ceases  to  die.  It  is  well 
to  greet  serenely  even  the  first  glimmer  of  the  dawn 
when  we  see  it,  not  hastening  toward  it  with  undue 


A    PSYCHIATRIC    MILESTONE 

speed,  nor  leaving  the  sunset  without  gratitude  for 
the  dying  light  that  once  was  dawn." 

So  to-day  I  bring  to  you  from  the  New  York 
Academy  of  Medicine  felicitations  on  your  one 
hundredth  anniversary  and  greetings  to  your  guests 
who  have  come  from  all  over  the  world  to  join  in 
your  birthday  celebration. 


[88] 


ADDRESS      BY 

DR.     RICHARD     G.    ROWS 


The  Chairman:  Besides  the  Royal  Charter,  the 
New  York  Hospital  is  indebted  to  Great  Britain  for 
invaluable  encouragement  and  financial  aid  in  our 
natal  struggle  in  Colonial  days.  Dr.  Rows  has 
added  charmingly  to  that  debt  by  journeying  from 
London  to  take  part  in  these  exercises.  His  sub- 
ject will  be,  "THE  BIOLOGICAL  SIGNIFICANCE  OF 
MENTAL  ILLNESS." 

As  Director  of  the  British  Neurological  Hospital 
for  Disabled  Soldiers  and  Sailors,  at  Tooting,  he  is 
giving  the  community  and  the  medical  world  the 
benefit  of  his  rich  professional  experience  in  the 
trying  years  of  war  as  well  as  in  peace,  and  gaining 
fresh  laurels  as  he  marches,  like  Wordsworth's 
warrior,  "from  well  to  better,  daily  self-surpast." 


DR.  ROWS 

I  must  first  express  to  you  my  keen  appreciation 
of  the  high  honor  you  have  conferred  on  me  by  invit- 
ing me  to  come  from  England  to  address  you  on  the 
occasion  of  the  centenary  celebration  of  the  opening 
of  this  Hospital. 

It  is  perhaps  difficult  for  us  to  realize  what  re- 
sistances lay  in  the  way  of  reform  at  that  time, 
resistances  in  the  form  of  long-established  but  some- 
what limited  views  as  to  the  nature  of  mental  ill- 
nesses, as  to  whether  the  sufferer  was  not  reaping 
what  he  had  sown  in  angering  the  supreme  powers 
and  in  making  himself  a  fit  habitation  for  demons 
to  dwell  in;  in  the  form  of  a  lack  of  appreciation 
of  the  need  of  sympathy  for  those  who,  while  in  a 
disturbed  state,  offended  against  the  social  organism 
or  in  the  form  of  an  exaggerated  fear  which  com- 
pelled the  adoption  of  vigorous  methods  of  protect- 
ing the  social  organism  against  those  who  exhibited 
such  anti-social  tendencies.  The  men  and  women 
of  the  different  countries  of  the  world  who  recognized 
this  and  made  it  the  chief  of  their  life's  duties  to 
spread  a  wider  view  of  such  conditions  and  to  insist 

[93] 


A    PSYCHIATRIC    MILESTONE 

that  the  unfortunate  people  should  be  regarded  and 
treated  as  fellow  human  beings  will  ever  command 
our  admiration. 

By  the  courtesy  of  Dr.  Russell  I  have  had  an  op- 
portunity of  seeing  the  pamphlet  in  which  are  re- 
corded the  efforts  of  Mr.  Thomas  Eddy  in  the  year 
1815  to  move  his  colleagues  to  consider  this  matter.* 
The  result  of  those  efforts  was  the  establishment  of 
an  institution  on  Bloomingdale  Road. 

Various  changes  followed  until  we  arrived  at  the 
Bloomingdale  Hospital  of  to-day  with  its  large  and 
trained  staff  of  medical  officers,  who,  while  still 
recognizing  the  difficulties  of  the  task,  are  imbued 
with  a  hope  of  success  which  has  arisen  on  a  basis  of 
wider  knowledge,  but  which  was  unknown  to  many 
of  their  predecessors.  To  have  the  opportunity  of 
joining  with  you  in  celebrating  the  big  advance  made 
a  hundred  years  ago,  of  exchanging  ideas  with  you 
with  regard  to  the  difficulties  which  still  confront  us, 
whether  in  America  or  in  England,  and  which  de- 
mand a  united  effort  on  the  part  of  all  who  are 
interested  in  the  scientific  investigation  of  the  sub- 
ject, cannot  fail  to  afford  one  the  liveliest  satisfac- 
tion. 

In  the  brief  history  of  the  Hospital  prepared  by 
Dr.  Russell  we  find  the  recommendations  of  another 

*  See  Appendix  III,  p.  200. 

[94] 


BIOLOGICAL    SIGNIFICANCE 

reformer,  Dr.  Earle,  who  in  1848  was  evidently  still 
not  satisfied  with  the  treatment  provided  for  the 
sufferers  from  mental  illness. 

Both  Mr.  Eddy  and  Dr.  Earle  were  influenced  by 
their  observation  that  even  in  those  suffering  from 
mania  much  of  their  behavior  could  not  be  described 
as  irrational.  If  you  will  allow  me  I  will  quote  a 
sentence  of  two  from  each. 

Mr.  Eddy  said :  "  It  is  to  be  observed  that  in  most 
cases  of  insanity,  from  whatever  cause  it  may  have 
arisen  or  to  whatever  it  may  have  proceeded,  the 
patient  possesses  small  remains  of  ratiocination  and 
self-command;  and  although  they  cannot  be  made 
sensible  of  the  irrationality  of  their  conduct  or  opin- 
ions, yet  they  are  generally  aware  of  those  partic- 
ulars for  which  the  world  considers  them  proper 
objects  of  confinement."  With  reference  to  treat- 
ment Dr.  Earle  said:  "The  primary  object  is  to  treat 
patients,  so  far  as  their  condition  will  possibly  per- 
mit, as  if  they  were  still  in  the  enjoyment  of  the 
healthy  exercise  of  their  mental  faculties." 

To  superficial  observation  these  suggestions  might 
well  have  appeared  as  the  phantasies  of  dreamers 
and  perhaps  at  the  present  day  their  importance  is 
not  always  fully  appreciated.  Recent  advances  in 
knowledge,  however,  have  led  us  beyond  the  moral 
treatment  recommended  a  hundred  years  ago  and 

[95] 


A    PSYCHIATRIC    MILESTONE 

have  enabled  us  to  see  that  a  more  important  truth 
underlay  these  suggestions. 

We  are  all  familiar  with  the  frequent  difficulty 
we  encounter  in  our  efforts  to  discover  the  actual 
mental  disturbance  which  is  supposed  to  exist  in 
our  patients.  It  is  often  a  question  of  wit  against 
wit  as  between  patient  and  doctor,  and  not  infre- 
quently a  rational  and  intelligent  conversation  may 
be  maintained  on  an  indifferent  subject.  The  fact 
too  that  the  disturbance  is  so  frequently  only  tempo- 
rary suggests  that  the  loss  of  rational  control  is  a 
less  serious  phenomenon  than  was  generally  sup- 
posed and  we  know  that  the  control  can  be  frequently 
restored  by  a  period  of  rest  or  by  a  helpful  stimulus. 
Quite  recently  a  patient  who  in  hospital  had  been 
confused,  undisciplined,  abusive,  and  threatening, 
was  removed  to  a  house  of  detention.  The  shock 
of  finding  himself,  as  he  said,  amongst  a  lot  of  luna- 
tics, led  him  to  face  reality  from  a  fresh  point  of 
view.  He  admitted  that  it  had  taught  him  a  lesson 
and  when  he  revisited  the  hospital,  if  not  entirely 
grateful  to  us  for  the  experience,  he  evidently  bore 
no  ill  will. 

But  not  only  is  it  necessary  to  recognize  what 
rational  powers  remain  to  the  patient,  we  must  also 
inquire  how  much  in  their  disturbed  mental  activity 
can  be  considered  a  rational  reaction  to  the  stimuli 

[96] 


BIOLOGICAL    SIGNIFICANCE 

which  have  operated,  and  still  may  be  operating, 
on  them. 

In  connection  with  this  I  would  suggest  that  there 
are  two  aspects  to  be  considered.  First,  what  is  the 
standard  according  to  which  we  are  to  judge  them  ? 
Secondly,  to  what  extent  are  the  reactions  of  the 
patient  abnormal  in  kind  to  the  driving  stimulus  ? 
They  may  perhaps  be  reckoned  abnormal  in  degree, 
but,  to  what  extent,  if  at  all,  are  they  abnormal  in 
kind  ? 

It  may  be  readily  admitted  that  the  behavior  of 
those  suffering  from  mental  illness  offends  against 
conventional  usages  and  is  anti-social.  It  must  also 
be  recognized  that  amongst  human  beings  living 
in  aggregates  some  conventional  usages  must  be 
evolved  and  insisted  on  in  order  to  insure  the  great- 
est good  of  the  greatest  number.  These  usages  are 
regarded  not  merely  as  protective  measures  for  the 
body  corporate,  but  they  are  also  supposed  to  indi- 
cate a  beneficial  standard  for  the  individual.  But 
such  a  standard  being  adopted,  observation  is  liable 
to  be  limited  so  much  to  results  without  sufficient 
attention  being  given  to  the  causes  which  had  led  to 
those  results. 

By  the  recent  advances  in  scientific  knowledge 
and  in  methods  of  investigation  we  have  been  led  to 
see  that  the  conditions  under  consideration  cannot 

[97] 


A    PSYCHIATRIC   MILESTONE 

be  understood  without  a  study  of  the  mechanisms 
on  which  mental  activity  depends  and  without  dis- 
covering the  psychic  and  physical  causes,  arising 
from  without  and  from  within,  which  have  disturbed 
the  function  of  these  mechanisms.  We  have  learned 
that  these  illnesses  do  not  arise  from  one  cause  alone 
and  that  they  are  the  result  of  influences  to  which 
we  all  may  be  subject  to  some  degree. 

The  originator  of  these  modern  methods,  Prof. 
Freud,  has  stimulated  us  to  regard  the  ordinary 
symptoms  of  mental  illnesses  as  directing  posts 
indicating  lines  to  be  investigated,  and  he  and  others 
have  suggested  various  methods  which  may  usefully 
be  employed. 

It  is  essential  that  we  carefully  distinguish  what 
are  primary  from  what  are  secondary  symptoms. 
Two  thousand  years  ago  a  physican,  Areteus,  pointed 
out  that  mania  frequently  commenced  as  melan- 
cholia, and  he  drew  attention  to  the  extreme  fre- 
quency of  an  initial  depression  in  cases  of  mental 
illnesses.  But  he  did  not  offer  any  explanation  of 
this  initial  state. 

Such  an  initial  state  may  perhaps  be,  to  a  certain 
extent,  understood  if  we  assume  that  the  first  evi- 
dences of  mental  disturbance  consist  in  some  diffi- 
culty in  carrying  out  ordinary  mental  processes,  some 
difficulty  in  exercise  of  the  function  of  perceiving, 

[98] 


BIOLOGICAL    SIGNIFICANCE 

thinking,  feeling,  judging,  and  acting,  and  that  any 
disturbance  of  the  harmonious  activity  of  these  func- 
tions must  give  rise  to  an  emotional  condition  of 
anxiety  and  depression.  Some  such  disharmony 
will,  by  adequate  investigation,  be  found  in  a  large 
number  of  cases  to  exist  in  the  early  states  of  the 
illness  and  will  be  appreciated  by  the  patient  before 
there  occur  any  obvious  signs,  any  outward  manifes- 
tations of  disability. 

But  in  any  disharmony  which  may  occur  it  must 
be  recognized  that  the  mental  mechanisms  affected 
are  those  with  which  the  patient  was  originally  en- 
dowed, which  he  has  gradually  trained  throughout 
his  past  experience  and  which  he  has  employed  more 
or  less  successfully  up  to  the  time  the  illness  com- 
menced. There  is  no  new  mechanism  introduced 
to  produce  a  mental  illness,  but  a  putting  out  of 
gear  of  those  common  to  the  race  and  their  distur- 
bance is  the  result  of  the  action  of  influences  which 
may  befall  any  one  of  us,  unbearable  ideas  with 
which  some  intense  emotional  state  is  intimately 
associated.  The  normal  function  of  these  mech- 
anisms, simple  at  first  and  remaining  fundamentally 
unaltered,  although  possibly  much  modified  grad- 
ually by  added  experiences  from  within  and  with- 
out, depends  on  the  maintenance  of  a  harmonious 
balance  between  stimuli  received  and  emotional  re- 

[99] 


A    PSYCHIATRIC    MILESTONE 

action  and  motor  response  to  those  stimuli  so  that 
the  feeling  of  well-being  may  arise. 

If  from  any  cause  there  occurs  a  failure  to  appre- 
ciate the  stimuli  clearly,  if  the  emotional  reactivity 
be  disturbed,  if  the  sense  of  value  becomes  biassed 
in  one  direction  or  another  so  that  the  response  is 
recognized  by  the  patient  as  abnormal  there  will 
result  a  disharmony  and  a  feeling  of  ill-being  of  the 
organism.  Under  these  conditions  the  processes  of 
facilitation  along  certain  definite  lines  and  inhibi- 
tion of  all  other  lines — processes  which  are  essential 
to  clear  consciousness — will  become  difficult  or  per- 
haps impossible  and  a  mental  illness  will  develop. 
In  the  slighter  degrees  the  disharmony  may  be 
known  to  the  patient  without  there  being  any  out- 
ward manifestation  to  betray  the  conflict  going  on 
within.  In  the  severe  degrees  the  mental  activity 
of  the  patient  may  be  under  the  control  of  some 
dominant  emotional  state  so  that  it  may  be  impossi- 
ble for  him  to  adapt  himself  to  his  surroundings  in 
a  normal  manner  although  his  behavior  may  not 
appear  so  irrational  when  we  know  the  stimuli 
affecting  him.  Within  these  extremes  we  discover 
all  degrees  of  disturbance,  and  all  varieties  of  signs 
and  symptoms  may  be  encountered. 

But  the  signs  which  become  obvious  to  superficial 
observation  are,  to  a  large  extent,  secondary  prod- 


BIOLOGICAL    SIGNIFICANCE 

ucts.  The  primary  symptoms  are  felt  by  the  pa- 
tient as  a  disturbance  of  the  capacity  to  perceive, 
to  think,  to  feel,  to  judge,  and  to  act,  and  with  these 
disabilities  there  will  be  associated  a  certain  degree 
of  confusion  and  anxiety  which  cannot  fail  to  appear 
as  the  result  of  such  alterations  of  function. 

The  obvious  signs  may  represent  merely  a  more 
intense  degree  of  the  primary  affection,  disturbed 
capacity  together  with  some  confusion  and  anxiety; 
or  they  may  represent  efforts  on  the  part  of  the  pa- 
tient to  overcome  or  to  escape  from  the  disturbance 
or  to  explain  it  to  himself.  And  now  the  total  lack 
of  knowledge  of  the  processes  on  which  mental  ac- 
tivity depends,  the  altered  standard  of  judgment  due 
to  some  degree  of  dissociation,  and  the  necessity  of 
obtaining  relief  in  some  way  or  other  will  have  much 
to  do  with  determining  the  character  of  the  symp- 
toms with  which  we  are  all  familiar.  So  many  fac- 
tors are  concerned  in  the  production  of  these  secon- 
dary characters  that  it  is  difficult  to  assign  to  the 
symptoms  their  true  value  or  to  decide  whether  they 
possess  much  value  at  all  with  regard  to  the  funda- 
mental disturbance  which  constituted  the  primary 
illness.  So  often  they  appear  to  be  mere  rationali- 
zations, mere  false  judgments  on  the  part  of  the 
patient;  they  thus  form  subjects  for  investigation 
rather  than  fundamental  constituents  of  the  illness. 

[101] 


A    PSYCHIATRIC    MILESTONE 

We,  therefore,  must  not  accept  the  outward  and 
visible  signs  at  their  face  value  but  attempt  to  dis- 
cover what  past  experiences  in  the  life  of  the  patient 
have  led  to  such  disturbance  of  function,  to  such  a 
change  in  his  mental  activity. 

It  will  possibly  be  of  some  assistance  to  provide 
one  or  two  examples  in  order  to  demonstrate  the 
importance  of  the  past  experiences  as  agents  capable 
of  producing  such  alterations. 

The  first  case  will  illustrate  the  results  produced 
by  the  development  of  a  dominant  emotional  ten- 
dency during  early  childhood.  The  patient  up  to 
the  fifth  year  of  her  life  had  been  an  ordinary,  nor- 
mal child,  attached  to  her  mother,  fond  of  her  nurse, 
interested  in  her  toys.  During  the  next  two  years 
she  endured  much  bad  treatment  at  the  hands  of  a 
new  nurse  which  produced  such  an  impression  on 
her  that  she  felt  she  was  a  changed  child.  This 
nurse,  described  to  me  by  the  patient  as  a  handsome 
woman,  having  met  the  inevitable  man,  used  fre- 
quently to  meet  him  clandestinely.  The  child  was 
neglected,  was  sometimes  left  alone,  on  one  occasion 
in  a  graveyard,  but  she  was  forbidden  to  mention 
the  subject  to  any  one  under  threats  of  being  carried 
away  by  a  "bogey-man."  The  child  became  very 
frightened  by  this,  to  such  an  extent  that  one  night 
she  had  a  severe  nightmare  in  which  a  "  bogey-man " 

[  102] 


BIOLOGICAL    SIGNIFICANCE 

came  to  carry  her  away.  At  the  end  of  two  years  a 
profound  change  had  taken  place  in  her  which  she 
now  describes  thus:  "I  was  a  changed  child;  I  was 
separated  from  my  mother  and  could  no  longer  con- 
fide in  her  nor  did  I  wish  to  do  things  for  her  as  I 
had  done  before;  I  could  not  enjoy  my  toys;  I  had 
no  confidence  in  myself;  I  was  not  like  other  chil- 
dren." And  from  that  time  on,  as  girl  and  as  woman, 
she  has  never  felt  that  she  has  been  like  others  of  her 
sex.  Such  a  condition,  being  started  and  confined 
by  repetition,  interfered  with  her  free  development 
and  it  was  remarkable  how  many  incidents  occurred 
in  her  life  to  confirm  the  disability,  but  the  germ  of 
her  serious  breakdown  thirty  years  later  was  laid 
in  her  fifth  and  sixth  years. 

The  second  case  is  that  of  a  patient  who,  as  a 
child,  had  some  convulsive  attacks.  She  was  there- 
fore considered  delicate  and  was  thoroughly  spoiled. 
When  nearly  thirty  she  lived  through  a  sexual  exper- 
ience which  caused  extreme  anxiety;  she  broke  down 
and  was  admitted  to  an  asylum.  After  admission 
she  looked  across  the  dormitory  and  saw  a  head 
appearing  above  the  bed-clothes,  the  hair  of  which 
had  been  cut  short  for  hygienic  reasons.  With  a 
memory  of  her  sexual  indiscretion  still  vivid  in  her 
mind  she  jumped  to  the  conclusion  that  she  was  in  a 
place  where  men  and  women  were  crowded  together 

[  103  ] 


A    PSYCHIATRIC   MILESTONE 

in  the  same  room.  She  got  out  of  bed,  refused  to 
return  to  it,  fought  against  the  nurses  and  was  trans- 
ferred to  a  single  room,  with  the  mattress  on  the 
floor  and  the  window  shuttered.  She  wondered 
where  she  was  and  came  to  the  conclusion  that  she 
was  in  a  horse-box.  Then  arose  a  feeling  of  terror 
that  she  would  be  at  the  disposal  of  the  grooms 
when  they  returned  from  work.  The  sound  of 
heavy  footsteps  of  the  patients  passing  along  the 
corridor  to  the  tea-room  suggested  that  the  grooms 
were  returning  and  that  her  room  would  soon  be 
invaded.  The  feeling  of  terror  increased  and  she 
tried  to  hide  in  the  corner,  drawing  the  mattress  and 
clothes  over  her.  And  so  on. 

Months  later  when  I  had  my  first  interview  with 
her,  her  sole  remark  during  the  hour  was  "How  can 
I  speak  in  a  place  like  this?"  This  was  repeated 
almost  without  intermission  throughout  the  hour. 
It  formed  a  good  example  of  the  origin  of  the  process 
of  perseveration,  a  process  frequently  adopted  by 
the  patient  to  guard  against  the  disclosure  of  a 
troublesome  secret. 

If  we  attempt  to  trace  out  some  of  the  mecha- 
nisms employed  in  these  two  cases  we  shall  see  that 
in  response  to  definite  stimuli  each  reacted  in  a 
manner  which  cannot  be  considered  abnormal  in 
kind.  It  was  normal  reaction  for  the  child  to  be  dis- 

[  104] 


BIOLOGICAL    SIGNIFICANCE 

tressed  at  being  separated  from  her  mother  in  such 
a  way,  to  be  frightened  by  being  left  in  the  grave- 
yard alone,  or  at  the  threat  of  her  being  carried  away 
by  a  "bogey-man"  if  she  dared  to  mention  any- 
thing of  the  clandestine  meetings  to  her  mother. 
It  was  not  very  abnormal  that  after  her  sexual 
experience  the  other  patient  while  still  in  a  confused 
state  caused  by  the  intense  emotional  condition  of 
anxiety,  should,  on  seeing  a  head  with  the  hair 
cropped  short,  jump  to  the  conclusion  that  there  was 
a  man  in  a  bed  in  the  same  ward  with  herself,  or 
that  she  should  feel  frightened  and  wish  to  leave 
the  room. 

The  mental  activity  in  each  case  depended  on 
mental  content,  that  is,  memory  of  past  experiences 
with  their  intense  emotional  states  which  acted  as 
the  driving  force  and  also  made  the  recall  of  the 
experience  go  extremely  easy.  The  further  develop- 
ments after  being  placed  in  the  single  room  with 
mattresses  on  the  floor  and  the  window  shuttered 
were  rationalizations  also  based  on  mental  content, 
i.  e.y  on  the  memory  of  rooms  somewhat  similar  to 
that  in  which  she  found  herself  and  of  the  use  of 
such  rooms.  It  is  interesting  to  note  also  in  the 
first  case  that  in  her  wildest  delirium  during  an  acute 
attack  she  lived  through  episodes  of  her  past  life. 
One  example  may  be  given.  In  the  course  of  her 

[105] 


A    PSYCHIATRIC    MILESTONE 

delirium  she  thought  that  a  "blackbird"  had  flown 
to  her,  touched  her  left  wrist  and  taken  away  all 
her  vitality.  This  depended  on  an  experience  of 
her  going  to  Germany  when  a  girl  and  meeting  a 
young  German  officer  whom  she  did  not  like.  A  few 
years  later  she  went  to  Germany  and  met  the  officer 
again.  Without  going  into  full  details  I  may  say 
that  on  one  occasion  when  walking  with  him  he 
seized  her  left  wrist  with  his  right  hand  and  at- 
tempted to  kiss  her;  she  struggled  fiercely  and  ran 
from  him.  Here  we  see  that  not  only  is  her  delirium 
based  on  a  past  experience,  but  that  the  whole  mem- 
ory is  symbolized  in  the  "blackbird"  which  was 
the  emblem  of  the  German  nation  in  whose  army  the 
officer  was  then  serving.  Connected  with  this  there 
was  also  another  unpleasant  episode  which  dated 
from  her  tenth  year.  Much  of  her  delirium  was 
worked  out  in  such  a  way  that  most  of  the  details 
could  be  traced  back  to  experiences  of  her  earlier  life. 
But  however  absurd  her  statement  regarding  her 
being  touched  by  a  "  blackbird  "  and  all  her  vitality 
removed  might  appear  to  superficial  observation, 
it  must  be  admitted  that  when  we  know  the  mental 
content  of  that  patient,  we  cannot  but  see  that  at 
any  rate  it  was  not  so  irrational.  And  not  only  was 
this  recognized  by  the  doctor,  but,  and  this  is  much 
more  important,  by  the  patient  herself. 

[106] 


BIOLOGICAL    SIGNIFICANCE 

It  is,  therefore,  the  mental  content  which  must 
be  discovered  before  doctor  or  patient  can  under- 
stand the  disability  and  before  any  common  ground 
between  the  two  can  be  found.  And  when  the  men- 
tal content  is  known  it  will  be  easy  to  recognize 
the  affective  condition  of  the  patient  to  be  a  normal 
response.  It  will  also  be  specific  and  if  intense  will 
dominate  the  patient.  "  Why  is  it  I  can  never  feel 
joy  as  I  used  to  do  ? "  was  the  pathetic  inquiry  of 
the  patient  dominated  by  a  feeling  of  misery  and 
fear.  Was  it  not  for  the  reason  that  being  domi- 
nated by  misery  and  fear,  joy  could  find  no  place  ? 
The  emotion  of  misery  because  of  its  intensity  could 
more  or  less  inhibit  the  feeling  of  joy,  but  joy  could 
not  inhibit  the  misery. 

No  repetition  of  the  memory  of  the  unpleasant 
experiences  with  their  associated  emotion  of  misery 
and  fear  led  to  the  formation  of  a  habit  of  mind  and 
feeling.  And  when  once  such  a  habit  of  mind  is 
established  it  is  remarkable  by  what  a  host  of  stimuli 
received  in  ordinary  daily  life  the  cause  of  the  dis- 
turbance can  be  recalled. 

This  question  of  stimuli  deserves  further  notice. 
It  is  not  so  difficult  to  realize  the  mechanism  by 
which  a  stimulus  which  clearly  crosses  the  threshold 
of  consciousness  can  lead  to  a  given  reaction.  But 
it  is  perhaps  difficult  to  imagine  how  so  many  stimuli 

[  107] 


A    PSYCHIATRIC    MILESTONE 

which  do  not  cross  the  threshold  of  consciousness  or 
which,  if  they  do,  are  not  recognized  by  the  patient 
at  the  time  as  having  any  reference  whatever  to  the 
special  memory  can  yet  set  the  memory  mechanism 
into  action.  The  result  may  not  be  seen  till  after 
the  relapse  of  some  considerable  period  of  time,  as  in 
the  case  of  a  man  who  for  years  had  been  disturbed 
by  terrific  nightmares,  based  on  the  idea  of  snakes 
coming  out  of  the  ground  and  attacking  him.  He 
complained  one  day  that  he  was  much  worse,  that 
three  nights  before  he  had  had  the  worst  night- 
mare of  his  life.  On  being  questioned  as  to  what 
could  have  suggested  snakes  to  him  he  could  not 
tell.  A  few  minutes  later  he  said :  "  I  think  I  know 
the  cause  now.  I  spent  the  evening  before  I  had 
that  nightmare  with  a  sergeant  who  had  returned 
from  the  service  in  India."  This  friend  amongst 
other  things  had  mentioned  that  whenever  they  were 
about  to  bivouac  they  had  to  search  every  hole 
under  a  stone  and  every  tuft  of  grass  to  see  that 
there  were  no  snakes  there.  This,  which  had  been 
received  as  an  ordinary  item  of  information,  had 
been  the  stimulus  which  had  set  his  memory  me- 
chanism into  action  and  the  nightmare  between  two 
and  three  o'clock  in  the  morning  had  been  the  re- 
sult. 

The  result  in  many  instances  is  evidenced  by  an 

[108] 


BIOLOGICAL    SIGNIFICANCE 

emotional  state  alone  and  the  actual  memory  of  the 
original  experience  may  not  come  into  conscious- 
ness. Many  examples  of  this  might  be  given.  The 
sound  of  a  trolley  wheel  on  a  tram  wire  in  one  case 
gave  rise  to  terror  instead  of  its  normal  reaction, 
viz.,  that  of  satisfaction  at  getting  to  the  destination 
quickly  and  without  effort.  This  terror  was  pro- 
duced because  the  sound  on  the  wire  resembled  that 
of  a  shell  which  came  over,  blew  in  a  dugout,  killed 
three  men,  and  buried  the  patient.  No  memory 
of  this  incident  came  into  consciousness,  only  a 
terror  similar  to  that  experienced  at  the  time  of  the 
original  incident  was  experienced.  Or,  the  time 
four  o'clock  in  the  afternoon  could  act  as  a  stimulus 
to  arouse  an  emotional  state  of  misery  similar  to 
that  experienced  at  the  same  time  of  day  during 
an  illness  some  years  previously.  Or,  passing  the 
house  of  a  doctor  when  on  a  bus  could  produce  a 
sudden  outburst  of  anxiety,  giddiness,  and  confusion; 
the  patient  had  been  taken  into  that  house  at  the 
time  of  an  epileptic  attack.  Or,  showing  photo- 
graphs of  the  front  could  lead  to  an  epileptic  attack 
which  was  based  on  the  memory  of  the  time  when 
the  patient  was  wounded  in  the  head;  this  has  oc- 
curred on  two  separate  occasions  separated  by  an 
interval  of  some  months.  Or,  noticing  a  familiar 
critical  tone  in  a  remark  made  at  a  dinner-table 

[  109] 


A    PSYCHIATRIC    MILESTONE 

could  lead  to  an  acute  change  of  feeling  so  that  the 
subject  who,  before  dinner,  had  felt  she  would  like 
to  play  a  new  composition  on  the  piano  so  as  to 
obtain  the  opinion  of  the  guest  who  had  exhibited 
the  critical  tone,  after  dinner  felt  incapable  of  doing 
so.  Her  feelings  had  been  hurt  on  many  former 
occasions  by  critical  remarks  made  by  him  in  that 
tone.  The  critical  remarks  were  not  called  to  mem- 
ory but  there  arose  the  feeling  that  under  no  cir- 
cumstances could  she  play  that  piece  to  him. 

Of  special  importance  also  are  the  experiences  of 
childhood.  An  unhappy  home  or  unjust  treatment 
as  a  child  may  warp  the  development  of  the  per- 
sonality, lead  to  a  lack  of  self-confidence,  to  the 
predominance  of  one  emotional  tendency,  and  so 
prevent  that  balanced  equilibrium  which  will  allow 
a  rapid  and  suitable  emotional  reaction  such  as  we 
may  consider  normal.  This  may  lead  to  a  failure 
of  development  or  a  loss  of  the  sense  of  value,  be- 
cause the  existence  of  one  dominating  emotional 
tendency  so  often  produces  a  prejudiced  view  which 
may  render  a  just  appreciation  of  our  general  ex- 
perience almost  impossible  and  may  seriously  dis- 
turb our  mental  activity. 

And  if,  as  Bianchi  suggests,  all  mental  activity 
depends  on  a  series  of  reflex  actions,  or,  as  Bechterew 
and  Pavlov  have  insisted,  a  series  of  conditioned 

[no] 


BIOLOGICAL    SIGNIFICANCE 

reflexes  becomes  established,  it  will  assist  us  to 
understand  how  such  stimuli  can  give  rise  to  men- 
tal disturbances,  to  mental  illnesses.  We  shall  see 
that  there  may  be  something  of  real  importance 
underlying  such  remarks  as  "I  felt  I  was  a  changed 
child";  or  "It  is  because  of  the  treatment  I  received 
from  my  father  that  I  have  taken  life  so  seriously." 
"I  have  never  imagined  that  what  I  went  through 
in  my  childhood  could  so  influence  me  now";  or  "I 
have  never  had  confidence  in  myself  and  often  when 
I  have  appeared  vivacious  and  interested  I  have 
had  an  awful  feeling  of  incapacity  and  dread  within 
myself." 

The  outward  and  obvious  manifestations,  there- 
fore, are  not  necessarily  a  true  index  of  our  mental 
and  emotional  conditions.  This  is  true  of  all  men- 
tal illnesses,  even  the  most  severe. 

One  patient  who  had  been  in  an  asylum  more  than 
ten  years  illustrated  this  in  a  most  striking  manner. 
His  outward  manifestations  led  one  to  feel  that  he 
thought  he  possessed  the  institution  in  which  he 
was  confined  and  also  the  surrounding  property 
and  that  the  authorities  were  a  set  of  usurpers  and 
thieves  who  kept  him  incarcerated  in  order  that 
they  might  enjoy  what  was  really  his  money  and  his 
property.  On  one  occasion  I  said  to  him,  "George, 
what  is  that  incident  in  your  life  which  you  cannot 

[in] 


A    PSYCHIATRIC    MILESTONE 

forget  and  which  has  troubled  you  so  seriously?" 
The  reply  was  a  flood  of  abuse.  I  put  the  question 
to  him  several  times  without  getting  any  further 
answer,  but  when  I  came  to  leave  the  ward,  George 
came  up  behind  me  and  whispered  over  my  shoulder, 
"Who  told  you  about  it  ?"  No  abuse,  no  shouting 
as  usually  occurred,  but  a  whisper,  "Who  told  you 
about  it  ?"  Was  not  George  running  away  from  a 
memory  with  its  emotion  which  was  unbearable  to 
an  idea  which  allowed  him  to  be  angry  with  others 
instead  of  with  himself?  Many  examples  of  this 
might  be  given  and  really  might  be  found  by  us  in 
our  own  experience.  It  is  the  mental  content  which 
is  important,  a  mental  content  which  can  be  recalled 
by  various  stimuli,  and  which  will  be  more  persis- 
tently with  us  the  more  intense  is  the  emotion  asso- 
ciated with  it. 

But  the  basis  of  the  condition  is  not  completely 
understood  when  we  have  apparently  arrived  at  the 
psychic  cause  of  the  disturbance. 

It  is  recognized  that  the  emotions  are  accompanied 
by  physical  changes,  changes  which  are  specific  for 
each  emotional  state.  The  physical  changes  which 
normally  are  associated  with  fear  differ  from  those 
of  joy  or  anger.  This  has  been  appreciated  for  a 
long  time  but  recent  researches  have  recalled  other 
reactions  to  us.  Reactions  in  the  internal  glands 

[112} 


BIOLOGICAL    SIGNIFICANCE 

which  further  knowledge  will  probably  prove  to  be 
of  great  importance,  in  fact  to  form  an  integral  part 
of  the  sum  of  activities,  connect  with  mental  proc- 
esses. The  secretions  of  the  glands  exert  an  influ- 
ence on  the  sensibility  and  reaction  of  the  organs 
connected  with  psychic  phenomena  and  their  func- 
tions themselves  are  affected  by  reactions  occurring 
in  the  nervous  system.  Revival  of  a  memory  may 
thus  affect  the  functions  of  these  glands,  and  the 
changes  produced  in  them  may  react  on  the  sensi- 
bility and  reactivity  of  the  nervous  mechanisms. 
If  this  be  so,  it  will  be  evident  that  the  organism 
works  as  a  whole,  that  a  disturbance  of  one  organ 
may  interfere  with  the  function  of  another  and  that 
in  the  repetition  of  all  these  influences  we  may  find 
an  explanation  of  the  chronicity  of  many  of  these 
illnesses.  A  study  of  the  activities  and  interactivi- 
ties of  all  the  organs  of  the  body  is  therefore  essen- 
tial and  must  be  made  before  we  shall  understand 
the  biological  significance  of  mental  illness. 


ADD  RE  S  S      BY 

DR.    PIERRE    JANET 


The  Chairman :  Our  country  may  be  hesitating  a 
little — I  hope  it  will  not  be  for  long — in  joining  a 
league  of  nations  to  prevent  war,  but  there  can  be 
no  doubt  of  our  immediate  readiness  to  co-operate 
internationally  to  prevent  and  reduce  disease.  Our 
distinguished  guest  from  gallant  France,  Dr.  Pierre 
Janet,  professor  in  the  College  of  France,  evidently 
feels  confident  of  our  sympathy  and  willingness  to 
collaborate  in  this  latter  respect,  for  he  has  ven- 
tured across  the  ocean,  with  Madame  Janet,  in 
response  to  our  urgent  invitation.  His  introduc- 
tion to  an  audience  of  American  psychiatrists  would 
be  quite  out  of  place.  His  fame  as  a  pathological 
psychologist  has  circled  the  world.  In  the  science 
of  medicine  he  is  a  modern  Titan.  For  to-day's 
address  he  has  chosen  as  a  subject,  "THE  RELATION 
OF  THE  NEUROSES  TO  THE  PSYCHOSES." 


DR.  JANET 

Mr.  President,  my  dear  colleagues,  ladies,  and 
gentlemen:  The  Americans  and  the  French  have 
met  on  the  battle-fields  and  they  have  faced  together 
the  same  sufferings  for  the  defense  of  their  common 
ideal  of  civilization  and  liberty;  it  is  right  that  they 
should  meet  likewise  where  Science  stands  up  for 
the  protection  of  health  and  human  reason,  and 
that  they  should  celebrate  together  the  Festivals  of 
Peace.  The  President  and  the  organizers  of  this 
Congress  have  greatly  honored  me  in  asking  me  to 
represent  France  at  the  celebration  of  the  centenary 
of  the  Bloomingdale  Hospital;  but  above  all  they 
have  procured  me  a  great  pleasure  in  offering  me  the 
opportunity  of  coming  again  to  this  beautiful  land, 
of  meeting  once  more  friends  who  had  welcomed  us 
kindly  in  former  days;  our  old  friends  of  past  happy 
days  who  have  become  still  dearer  to  us  since  they 
have  been  tried  during  the  bad  days. 

Allow  me,  in  the  first  place,  to  present  you  with 
the  best  wishes  of  the  French  Government  who  have 
had  the  kindness  to  charge  me  to  interpret  the  senti- 
ments of  sympathy  which  they  feel  for  all  mani- 
festations tending  to  render  the  relations  that  unite 


A    PSYCHIATRIC   MILESTONE 

our  two  countries  closer  and  more  fruitful.  The 
Academy  of  Moral  and  Political  Sciences  has  equally 
charged  me  to  assure  you  that  it  is  happy  to  be 
represented  by  one  of  its  members  at  the  commemo- 
ration of  the  centenary  of  Bloomingdale  Hospital 
that  has  so  brilliantly  and  generously  continued  the 
tradition  of  Pinel  and  Esquirol.  The  Academy  takes 
a  lively  interest  in  the  psychological  and  moral 
studies  of  this  Congress  that  seek  the  cure  of  diseases 
of  the  mind  and  the  lessening  of  mental  disorders. 
The  Medico-Psychological  Society,  the  Society  of 
Neurology,  the  Society  of  Psychology,  the  Society 
of  Psychiatry  of  Paris  are  happy  to  take  part  in 
these  festivals  and  are  desirous  of  associating  still 
more  closely  their  work  to  that  of  the  scientific 
societies  of  the  United  States. 

The  celebration  of  the  centenary  of  a  lunatic 
asylum  gives  birth  to-day  to  a  national  festivity  in 
which  all  civilized  nations  participate.  This  is  a 
fact  that  would  have  well  astonished  the  first  founders 
of  lunatic  asylums,  the  Pinels,  the  Esquirols,  the 
William  Tukes,  and  the  first  organizers  of  Blooming- 
dale.  The  public  opinion  respecting  the  diseases  of 
the  mind,  the  care  to  be  given  to  lunatics,  is  vastly 
different  to  what  it  was  a  century  ago.  This  trans- 
formation of  ideas  has  taken  place,  in  a  great  measure, 
as  a  result  of  the  studies  devoted  to  neuroses  and 

[  120] 


NEUROSES   AND    PSYCHOSES 

that  is  why  it  seems  to  me  interesting  to  present 
you  to-day  with  a  few  reflections  on  the  connections 
which  unite  neuroses  and  psychoses;  for  it  is  the  dis- 
covery of  these  connections  that  has  shown  to  the 
man  sound  in  mind,  or  who  imagines  himself  to  be 
so,  how  near  he  always  was  to  being  a  lunatic  and 
how  wise  it  was  always  to  consider  the  lunatic  as  a 
brother. 

Formerly  a  lunatic  was  considered  as  a  separate 
being,  quite  apart  from  other  members  of  society. 
The  old  prejudices  which  banished  the  patient  from 
the  tribe  as  a  useless  and  dangerous  individual  had 
diminished  no  doubt  with  respect  to  the  diseases  of 
the  body,  which  were  more  and  more  regarded  as 
frequent  and  natural  things  to  which  each  of  us 
might  be  exposed.  But  these  prejudices  persisted 
with  respect  to  some  sexual  diseases  that  were  still 
considered  ignominious  and  chiefly  with  respect  to 
diseases  of  the  mind.  No  doubt  some  intelligent 
and  charitable  physicians  took  interest  in  the  luna- 
tic, endeavored  to  spare  him  many  sufferings,  to 
defend  him,  to  take  care  of  him.  But  the  people 
feared  the  lunatic  and  despised  him  as  if  he  had 
been  struck  by  some  malediction  which  excommuni- 
cated him.  I  have  seen  lately  a  patient's  parents 
upset  with  emotion,  as  they  had  to  cross  the  gardens 
of  the  asylum  to  visit  their  daughter,  at  the  single 

[121] 


A    PSYCHIATRIC   MILESTONE 

thought  that  they  might  catch  sight  of  a  lunatic. 
This  individual,  in  fact,  had  lost  in  the  eyes  of  the 
public  the  particular  quality  of  man,  reason,  which, 
it  appears,  distinguishes  us  from  beasts;  he  seemed 
still  living,  but  he  was  morally  dead;  he  was  no  longer 
a  man. 

No  doubt  it  was  a  dreadful  misfortune  when  some 
member  of  a  family  became  insane,  but  this  terrible 
calamity,  which  nothing  could  make  one  anticipate 
or  avoid,  was  happily  exceptional,  like  thunderbolts. 
The  other  men  and  even  the  members  of  the  family 
presented  nothing  similar  and  regarded  themselves 
with  pride  as  very  different  to  this  wretched  being 
transformed  into  a  beast.  This  victim  of  heavenly 
curse  was  pitied,  settled  comfortably  in  a  nice  pa- 
vilion at  Bloomingdale  and  never  more  spoken  of. 
People  still  preserve  on  this  point  ideas  similar  to 
those  they  had  formerly  about  tuberculosis,  known 
only  under  the  form  of  terrible  but  exceptional 
pulmonary  consumption.  Now  it  has  at  last  been 
understood  that  there  are  slight  tuberculoses,  cura- 
ble, but  tremendously  frequent.  It  will  be  the  same 
with  mental  disorders;  one  day  it  will  be  recognized 
that  under  diverse  forms,  more  or  less  attenuated 
they  exist  to-day  on  all  sides,  among  a  crowd  of 
individuals  that  one  does  not  feel  inclined  to  con- 
sider as  insane. 

[  122] 


NEUROSES   AND    PSYCHOSES 

Little  by  little,  in  fact,  men  have  had  to  state  with 
astonishment  that  all  lunatics  were  not  at  Bloom- 
ingdale.  Outside  the  hospital,  in  the  family  of  the 
unfortunate  lunatic,  or  even  in  other  groups,  one 
observed  strange  complaints,  moanings  relating  to 
lesions  which  were  not  visible,  inability  to  move 
notwithstanding  the  apparent  integrity  of  the  organs, 
contradictory  and  incomprehensible  affirmations;  in 
one  word,  abnormal  behaviors,  very  different  to 
normal  behaviors,  regularized  by  the  laws  and  by 
reason. 

What  was  the  meaning  of  these  queer  behaviors  ? 
At  first  they  were  very  badly  understood;  they  were 
supposed  to  have  some  connection  with  being  pos- 
sessed (with  the  devil),  with  miasmata,  vapors, 
unlikely  perturbations  of  the  body  and  animal 
spirits  that  circulated  in  the  nerves.  One  spoke, 
as  did  still  Prof.  Pomme  at  the  end  of  the  eigh- 
teenth century,  "of  the  shrivelling  up  of  the  nerves."* 
But  above  all,  one  preserved  the  conviction  that 
these  queer  disorders  were  very  different  to  the 
mental  disorders  of  lunacy.  These  peculiar  indi- 
viduals had,  it  was  said,  all  their  reason;  they 
remained  capable  of  understanding  their  fellow 
creatures  and  of  being  understood  by  them;  they 
were  not  to  be  expelled  from  society  like  the  poor 

*  Cf.  Janet,  P.,  Les  nevroses,  1909,  p.  370. 
[  123  ] 


A    PSYCHIATRIC    MILESTONE 

lunatics;  therefore  their  illness  should  be  anything 
but  the  mental  disorders  of  lunacy. 

Physicians,  as  it  is  just,  watched  their  patients 
and  only  confirmed  their  opinion  by  fine  scientific 
theories.  They  christened  these  new  disorders  by 
the  name  of  neuroses,  reserving  the  name  of  psychoses 
for  the  mental  disorders  of  lunatics.  During  the 
whole  of  the  nineteenth  century  the  radical  division 
of  neuroses  and  psychoses  was  accepted  as  a  dogma; 
on  the  one  side,  one  described  epilepsies,  hysterias, 
neurasthenias;  on  the  other,  one  studied  manias, 
melancholias,  paranoias,  dementias,  without  pre- 
occupying oneself  in  the  least  with  the  connections 
those  very  ill-defined  disorders  might  have  the  ones 
with  the  others.  This  division  was  accentuated  by 
the  organization  of  the  studies  and  the  treatment 
of  the  patients.  The  houses  that  received  the 
neurotic  patients  and  the  insane  were  absolutely 
distinct.  The  physicians  who  attended  the  ones 
and  the  others  were  different,  and  even  supplied 
by  different  competitions.  In  France,  even  now, 
the  recruiting  of  asylum  house  pupils  and  hospital 
house  pupils,  the  recruiting  of  asylum  doctors  and 
that  of  hospital  doctors,  give  an  opportunity  for 
different  competitions.  One  might  almost  say  that 
these  two  categories  of  house  pupils  and  doctors 
have  quite  a  different  education.  The  result  was 

[  124] 


NEUROSES   AND    PSYCHOSES 

that  the  examination  of  the  patients,  the  study  there- 
of, and  even  their  treatment,  were  for  the  most  part 
often  conceived  in  quite  a  different  manner.  For 
example,  neuroses  were  studied  publicly;  the  exami- 
nation was  on  elementary  sensibilities,  the  move- 
ments of  the  limbs,  and  especially  reflexes;  the  in- 
sane were  more  closely  examined  in  the  mental 
point  of  view,  in  conversations  held  with  them  by 
the  physician  alone.  Their  arguments,  their  ideas 
were  noted  more  than  their  elementary  movements. 
Strange  to  say,  just  when  the  psycho-therapeutic 
treatments  by  reasoning  and  moralizing  with  the 
patients  were  being  developed,  they  stood  out  the 
contrary  of  what  one  might  have  supposed — that 
this  treatment  should  be  applied  to  neurotic  patients 
alone.  It  was  admitted  that  lunatics  were  probably 
not  able  to  feel  this  moral  and  rational  influence; 
they  were  treated  by  isolation,  shower-baths,  and 
purgatives. 

This  complete  division  did  not  fail  to  bring  about 
singular  and  unfortunate  consequences.  In  a  hos- 
pital such  as  La  Salpetriere  the  tic  sufferers,  the 
impulsive,  those  beset  with  obsessions,  the  hysteri- 
cal with  fits  and  delirium  were  placed  near  the  or- 
ganic hemiplegics  and  the  tabetics  who  did  not 
resemble  them  in  the  least,  and  completely  separated 
from  the  melancholic,  the  confused,  the  systematical 


A    PSYCHIATRIC    MILESTONE 

raving,  notwithstanding  evident  analogies.  If  Char- 
cot  who,  moreover,  has  brought  about  so  much  prog- 
ress in  these  studies,  committed  some  serious  errors 
in  the  interpretation  of  certain  phenomena  of  hys- 
teria, is  it  not  greatly  due  to  his  having  studied  these 
neurotic  patients  with  the  neurology  methods  with- 
out ever  applying  psychiatry  methods  ?  Is  it  not 
strange  to  refuse  psychological  treatment  precisely 
to  those  who  present  psychological  disorders  to  the 
highest  degree,  and  to  place  the  insane  who  thinks 
and  suffers  altogether  outside  of  psychology  ? 

In  fine,  this  distinction  between  the  neurotic 
sufferer  and  the  mental  sufferer  was  mostly  arbi- 
trary and  depended  more  than  was  believed  on  the 
patient's  social  position  and  fortune.  Important 
and  rich  families  could  not  be  resigned  to  see  one  of 
their  members  blemished  by  the  name  of  lunatic, 
and  the  physician  very  often  qualified  him  as  neu- 
rasthenic to  please  the  family.  A  few  years  ago  this 
distinction  of  the  patients  and  of  the  physicians 
gave  rise  to  a  very  amusing  controversy  in  the 
newspapers.  The  professor  of  the  clinic  for  diseases 
of  the  nervous  system  asserted  that  neurotic  suf- 
ferers should  be  patients  set  apart  for  neurologist 
physicians  alone,  whereas  the  alienist  should  con- 
tent himself  with  real  lunatics.  The  professor  of 
the  clinic  for  mental  diseases  protested  with  much 


NEUROSES   AND    PSYCHOSES 

wit  and  claimed  the  right  of  attending  equally  the 
neurotic  patients.  All  this  proved  a  great  confusion 
in  the  ideas. 

Notwithstanding  these  difficulties,  Charcot's  stud- 
ies themselves  on  hysterical  accidents  began  to  make 
people's  minds  uneasy  and  to  modify  conceptions 
of  neuroses.  They  showed  that  neurotic  suffer- 
ers presented  disorders  in  their  thoughts,  that  many 
of  their  accidents,  in  all  appearance  physical,  were 
in  connection  with  ideas,  with  the  conviction  of 
paralysis,  of  illness,  with  the  remembrance  of  such 
or  such  an  event  which  had  determined  some 
great  emotion.  Without  doubt,  this  interpretation 
of  hysteria,  which  I  have  myself  contributed  to 
extend,  must  never  be  exaggerated,  and  it  must 
not  be  concluded  from  this  that  every  neuropathic 
accident  always  and  solely  depends  on  some  remem- 
brance or  some  emotion.  In  my  opinion,  this  is 
only  exact  in  a  very  limited  number  of  cases;  and 
then  it  only  explains  the  particular  form  of  such  or 
such  an  accident  and  not  the  entire  disease.  With- 
out doubt  it  seems  to  me  exaggerated  to-day  to  see 
in  neuroses  those  psychological  disorders  alone, 
whereas  the  disorders  of  the  circulation,  the  disorders 
of  internal  secretions,  the  disorders  of  the  functions 
of  the  sympathetic  which  will  be  spoken  of  just 
here  must  also  have  a  great  importance.  But, 

[  127] 


A    PSYCHIATRIC    MILESTONE 

however,  this  observation  proved  very  useful  at 
that  moment.  A  remembrance,  an  emotion,  are 
evidently  psychological  phenomena,  and  to  connect 
neuropathic  disorders  with  facts  of  the  kind  is  to 
include  the  study  thereof  with  that  of  mental  dis- 
orders. At  this  time,  in  fact,  they  began  to  repeat 
on  all  sides  a  notion  that  had  already  been  indicated 
in  a  more  vague  manner;  it  is  that  neuroses  were  at 
the  root,  were  in  reality  diseases  of  the  mind. 

If  such  is  the  case,  what  becomes  of  the  classical 
distinction  between  neuroses  and  psychoses  ?  No 
one  can  deny  that  the  latter  are  above  all  diseases 
of  the  mind  and  we  have  here  to  review  the  reasons 
which  seem  to  justify  their  complete  separation. 
Will  it  be  said  that  with  psychoses  the  disorders 
of  the  mind  last  very  much  longer  ?  But  some  pa- 
tients who  enter  the  asylum  with  a  certificate  of 
insanity  are  very  frequently  cured  in  a  few  months 
and  some  neuropathic  disorders  may  last  years.  I 
could  name  you  patients  who  since  thirty  years  keep 
the  same  obsessions,  and  who  at  the  age  of  fifty 
still  ask  themselves  questions  upon  their  pact  with 
heaven,  as  they  did  at  the  age  of  twenty.  Shall  we 
speak  of  the  consciousness  the  patient  has  of  his 
state  ?  But  this  consciousness  may  be  complete  in 
certain  melancholies  and  very  incomplete  in  certain 
impulsions. 

[128] 


NEUROSES   AND    PSYCHOSES 

Is  it  necessary  to  insist  on  the  presence  or  absence 
of  anatomical  lesions  which  one  tries  to  ascertain 
at  the  post-mortem  examination  ?  Shall  we  say 
with  Sandras,  Axenfeld,  Huchard,  Hack,  Tuke,  that 
neuroses  are  diseases  without  lesions  ?  One  finds 
lesions  in  general  paralysis  which  is  ranged  with 
insanity  and  we  find  some  also  in  epilepsies  which  are 
considered  as  neuroses;  one  no  more  finds  lesions  in 
melancholic  conditions  than  in  conditions  of  obses- 
sions. Besides,  as  I  have  often  repeated,  this  ab- 
sence of  lesions  is  of  no  importance;  it  is  quite  in 
keeping  with  our  ignorance.  Every  one  admits  that 
organic  alterations  more  or  less  momentary,  but 
actually  not  suspected,  must  exist  in  neuroses  as  in 
other  diseases.  Neuroses  as  well  as  psychoses  are 
much  more  likely  to  be  diseases  with  unknown  lesions 
than  diseases  without  lesions,  and  it  is  impossible 
to  take  this  characteristic  into  account  to  distin- 
guish the  ones  from  the  others. 

In  reality,  the  notion  of  lunatic  has  lost  its  former 
superstitious  signification  and  it  has  taken  no  pre- 
cise medical  signification.  That  word  is  now  the 
term  of  the  police  language.  It  indicates  only  an 
embarrassment  felt  by  the  police  before  certain 
persons'  conduct.  When  an  individual  shows  him- 
self to  be  dangerous  for  others,  the  public  adminis- 
tration has  the  habit  of  defending  us  against  him  by 

[  129] 


A   PSYCHIATRIC   MILESTONE 

the  system  of  threats  and  punishments.  As  a  rule, 
in  fact,  when  a  normal  mind  is  in  question,  threats 
can  stop  him  before  the  execution  of  crime,  and 
punishments,  when  crime  has  been  committed,  can 
prevent  him  from  beginning  again;  that  is  the  psy- 
chological fact  which  has  given  birth  to  the  idea  of 
responsibility.  But  in  certain  disorders  it  becomes 
evident  that  neither  threats  nor  punishments  have 
a  favorable  effect,  for  the  individual  seems  to  have 
lost  the  phenomenon  of  responsibility.  When  an 
individual  shows  himself  to  be  dangerous  for  others 
or  for  himself,  and  that  he  has  lost  his  responsibility, 
we  can  no  longer  employ  the  ordinary  means  of 
defense;  we  are  obliged  to  defend  ourselves  against 
him,  and  defend  him  against  himself  by  special 
means  which  it  is  useless  to  apply  to  other  men;  we 
are  obliged  to  modify  legal  conduct  toward  him. 
All  disorders  of  the  mind  oblige  us  to  modify  our 
social  conduct  toward  the  patient,  but  only  in  a 
few  cases  are  we  obliged  to  modify  at  the  same  time 
our  legal  conduct;  and  these  are  the  sort  of  cases 
that  constitute  lunacy. 

This  important  difference  in  the  police  point  of 
view  is  of  no  great  importance  in  the  psychological 
point  of  view  nor  in  the  medical  point  of  view,  for 
the  danger  created  by  the  patient  is  extremely  va- 
ried. It  is  impossible  to  say  that  such  or  such  a  dis- 

[  130] 


NEUROSES   AND    PSYCHOSES 

order  defined  by  medicine  leaves  always  the  patient 
inoffensive  and  that  such  another  always  renders 
him  dangerous.  There  are  melancholies,  general 
paralytics,  insane  who  are  inoffensive,  and  whom 
one  should  not  call  lunatics;  there  are  impulsive 
psychasthenics  who  are  dangerous  and  whom  one 
shall  have  to  call  lunatics.  The  danger  created  by 
a  patient  depends  a  great  deal  more  upon  the  social 
circumstances  in  which  he  lives  than  upon  the  na- 
ture of  his  psychological  disorders.  If  he  is  rich,  if 
he  has  no  need  to  earn  his  living,  if  he  is  surrounded 
by  devoted  watchfulness,  if  he  lives  in  the  country, 
if  his  surroundings  are  simple,  the  very  serious  men- 
tal disorders  he  may  have  do  not  constitute  a  dan- 
ger. If  he  is  poor,  if  he  has  to  earn  his  living,  if  he 
lives  alone  in  a  large  town  and  his  position  is  deli- 
cate and  complex,  the  same  mental  disorders,  exactly 
at  the  same  degree,  will  soon  constitute  a  danger, 
and  the  physician  will  be  forced  to  place  him  in  an 
asylum  with  a  good  certificate.  This  is  a  practical 
distinction,  necessary  for  order  in  towns,  which  has 
no  importance  in  the  point  of  view  of  medical 
science.*  If  we  put  these  accidental  and  slightly 
important  differences  on  one  side,  we  certainly  see  a 
common  ground  in  neuroses  and  psychoses.  The 
question  is  always  an  alteration  in  the  conduct,  and, 

*  Cf.  Les  Medications  psychologiques,  1920,  I,  p.  112. 

[131] 


A    PSYCHIATRIC    MILESTONE 

above  all,  in  the  social  conduct,  an  alteration  which 
tends,  if  I  am  not  mistaken,  toward  the  same  part 
of  the  conduct. 

The  conduct  of  living  beings  is  a  special  form  of 
reaction  by  which  the  living  being  adapts  himself  to 
the  society  to  which  he  belongs.  The  primitive 
adaptations  of  life  are  characterized  by  the  organiza- 
tion of  internal  physiological  functions.  Later  on 
they  consist  in  external  reactions,  in  displacements, 
in  uniform  movements  of  the  body  which  either 
keep  him  from  or  draw  him  near  to  the  surrounding 
bodies.  The  first  of  these  movements  are  the  reflex 
movements,  then  are  developed  those  combinations 
of  movements  which  we  called  perceptive  or  suspen- 
sive actions  in  keeping  with  perceptions.  Later 
came  the  social  acts,  the  elementary  intellectual 
acts  which  gave  birth  to  language,  the  primitive 
voluntary  acts,  the  immediate  beliefs,  then  the  re- 
flected acts,  the  rational  acts,  experimental,  etc.  As 
I  said  formerly,  there  is,  in  each  function,  quite  a 
superior  part  which  consists  in  its  adaptation  to  the 
particular  circumstance  existing  at  the  present  mo- 
ment. The  function  of  alimentation,  for  instance, 
has  to  exercise  itself  at  this  moment  when  I  am  to 
take  aliments  on  this  table  in  the  midst  of  new  peo- 
ple, that  is  to  say,  among  whom  I  have  not  yet 
found  myself  in  this  circumstance,  wearing  a  spe- 

[  132] 


NEUROSES    AND    PSYCHOSES 

cial  dress  and  submitting  my  body  and  my  mind  to 
very  particular  social  rites.  In  reality  it  is  never- 
theless the  function  of  alimentation,  but  it  must  be 
noted  that  the  act  of  dining,  when  wearing  a  dress 
suit  and  talking  to  a  neighbor,  is  not  quite  the  same 
physiological  phenomenon  as  the  simple  secretion 
of  the  pancreas.  Certain  patients  lose  only  the 
superior  part  of  this  function  of  alimentation  which 
consists  in  eating  in  society,  in  eating  in  new  and 
complex  circumstances,  in  eating  while  being  con- 
scious of  what  one  is  doing,  and  in  submitting  to 
rules.  Although  the  physiologist  does  not  imagine 
that  these  functions  are  connected  with  the  exercise 
of  sexual  functions  in  humanity,  there  is  a  pathology 
of  the  betrothal  and  of  the  wedding-tour. 

It  is  just  on  this  superior  part  of  the  functions,  on 
their  adaptation  to  present  circumstances,  that  the 
disorders  of  conduct  (self-government)  which  occupy 
us  to-day  bear.  If  one  is  willing  to  understand  by 
the  word  "evolution"  the  fact  that  a  living  being 
is  continually  transforming  himself  to  adapt  him- 
self to  new  circumstances,  neuroses  and  psychoses 
are  disorders  or  halts  in  the  evolution  of  functions, 
in  the  development  of  their  highest  and  latest  part.* 

This  halt  in  evolution  can  be  connected  with  differ- 
ent physiological  causes,  hereditary  weaknesses  of 

*"Les  Nevroses,"  1909,  p.  384. 
[  133  ] 


A    PSYCHIATRIC    MILESTONE 

origin,  infections,  intoxications,  disorders  of  internal 
secretions,  disorders  of  the  sympathetic  system. 
These  diverse  etiologies  will  most  likely  be  of  use  later 
to  distinguish  between  forms  of  these  diseases;  but 
to-day  the  common  character  of  neuroses  and  psy- 
choses is  that  this  diminution  of  vitality  bears  upon 
the  highest  functions  of  self-government. 

Whatever  be  the  disorders  you  may  consider, 
aboulias,  hysterical  accidents,  psychasthenic  ob- 
sessions, periodical  depressions,  melancholies,  sys- 
tematized deliriums,  asthenic  insanity,  you  will  al- 
ways find  a  number  of  facts  resulting  from  this 
general  perturbation. 

In  plenty  of  cases,  the  acts,  far  from  being  di- 
minished, appear  exaggerated;  the  patient  moves 
about  a  great  deal,  he  accomplishes  acts  of  defense, 
of  escape,  of  attack,  he  speaks  enormously,  he  seems 
to  evoke  many  remembrances  and  combine  all  sorts 
of  stories  during  interminable  reveries.  But  pray 
examine  the  value  and  the  level  of  all  these  acts; 
they  are  mere  gestures,  shocks  of  limbs,  laughter, 
sobs,  reactions  simply  reflex  or  perceptive,  in  con- 
nection with  immediate  stimulation,  with  inhibi- 
tion, without  choice,  without  adaptation  by  reflec- 
tion. The  thoughts  that  fill  these  ruminations  are 
childish  and  stupid,  just  as  the  acts  are  vulgar  and 
awkward;  there  is  a  manifest  return  to  childhood 


NEUROSES   AND    PSYCHOSES 

and  barbarism.  The  behavior  of  the  agitated  indi- 
vidual is  well  below  that  which  he  should  show  nor- 
mally. It  is  easy  to  explain  these  facts  in  the  lan- 
guage we  have  adopted.  The  agitation  consists  in 
an  activity,  more  less  complete,  in  inferior  tenden- 
cies very  much  below  those  the  subject  should  nor- 
mally utilize. 

It  is  that  in  reality  the  agitation  never  exists 
alone,  it  is  accompanied  by  another  very  important 
phenomenon  which  it  dissimulates  sometimes,  I 
mean  the  depression  characterized  by  the  diminu- 
tion or  the  disappearance  of  superior  actions,  apper- 
taining to  the  highest  level  of  our  hierarchy.  It  is 
always  observed  that  with  these  patients  certain 
actions  have  disappeared,  that  certain  acts  executed 
formerly  with  rapidity  and  facility  can  no  longer 
be  accomplished.  The  patients  seem  to  have  lost 
their  delicacy  of  feeling,  their  altruism,  their  intelli- 
gent critique.  The  stopping  of  tendencies  by  stimu- 
lation, the  transformation  of  tendencies  into  ideas, 
the  deliberation,  the  endeavor,  the  reflection;  in 
one  word,  both  the  moral  effort  and  the  call  upon 
reserves  for  executing  painful  acts  are  suppressed. 
There  exists  visibly  a  lowering  of  level,  and  it  is 
right  to  say  that  these  patients  are  below  themselves. 

The  two  phenomena,  agitation  and  depression, 
are  almost  always  associated  in  neuroses  as  well  as 


A    PSYCHIATRIC    MILESTONE 

in  psychoses.  It  is  likely  that  their  union  depends 
upon  some  very  general  law,  relating  to  the  exhaus- 
tion of  psychological  forces.  It  is  probable  that  the 
superior  phenomena  exact  under  a  form  of  concen- 
tration, of  particular  tension,  much  more  power 
than  acts  of  an  inferior  order,  although  the  latter 
seem  more  violent  and  more  noisy.  "When  the 
force  primitively  destined  to  be  spent  for  the  pro- 
duction of  a  certain  superior  phenomenon  has  be- 
come impossible,  derivations  happen,  that  is  to  say, 
that  this  force  is  spent  in  producing  other  useless 
and  especially  inferior  phenomena."  * 

A  very  great  number  of  phenomena  observed  in 
neuroses  and  psychoses  are  in  connection  with  de- 
pression and  agitation.  Convulsive  attacks,  di- 
verse fits  of  agitation,  prove  to  us  that  before  the  fit 
there  existed  disproportion  between  the  quantity 
and  the  tension  of  the  psychological  forces,  and  that 
the  spending  of  forces  during  the  fit  re-establishes 
the  equilibrium.  But  at  the  same  time,  after  this 
spending,  one  observes  a  notable  lowering  of  the 
mental  level,  a  real  psycholepsy.  It  is  very  likely 
that  studies  of  this  kind  will  produce  some  day  the 
key  of  the  epilepsy  problem,  for  vertigos  and  cer- 
tain epileptic  fits  are  certainly  phenomena  of  re- 
laxation, the  meaning  of  which  we  do  not  compre- 

*  Cf.  Janet,  P.,  "Obsessions  et  Psychestenic,"  1903,  vol.  I,  p.  997. 

[136] 


NEUROSES   AND    PSYCHOSES 

hend  because  we  do  not  study  sufficiently  the  state 
of  psychological  tension  before  and  after  the  acci- 
dents. 

The  difficulty  of  accomplishing  superior  acts,  the 
exhaustion  resulting  from  their  accomplishment, 
renders  them  fearful  to  the  patient  who  has  the  fear, 
the  phobia  of  these  acts,  just  as  he  has  the  terror  of 
that  depression  which  gives  the  feeling  of  the  dimi- 
nution of  life.  The  shrinking  of  activity  and  con- 
science, phobias,  negativisms,  generally  take  their 
starting  point  in  this  fear  of  exhaustion  caused  by 
some  difficult  action.  In  other  cases  the  patient 
feels  incapable  of  accomplishing  correctly  the  re- 
flected acts  necessary  to  social  and  moral  life,  and 
feeling  no  longer  protected  by  reflection,  he  is  afraid 
of  willing  or  believing  something,  as  one  is  afraid  of 
walking  in  a  dangerous  path,  when  one  cannot  see. 
The  vertigo  of  life  produces  itself  like  the  vertigo 
of  heights,  when  one  is  not  sure  of  oneself. 

Depressed  patients  have  felt,  wrongly  or  rightly, 
a  certain  excitation  after  a  certain  action.  Through 
some  curious  mechanism,  certain  acts,  instead  of 
exhausting  them,  have  raised  their  psychological 
tension.  The  need,  the  desire  to  raise  themselves 
inspires  them  with  the  wish  to  renew  such  acts,  and 
we  behold  the  impulsions  to  absorb  poisons,  impul- 
sions to  command,  to  theft,  to  aggression,  to  extraor- 

[  137] 


A    PSYCHIATRIC    MILESTONE 

dinary  acts,  varied  impulsions  which  play  a  great 
part  in  psychoses  as  well  as  in  neuroses. 

I  shall  not  insist  any  more  on  a  very  interesting 
phenomenon  in  connection  with  the  oscillations  of 
the  mind  and  which  still  plays  a  great  part  in  these 
diseases.  I  am  speaking  of  the  change  of  feeling 
which  may  accompany  the  same  action  in  the  course 
of  the  oscillations  of  the  mind.  At  the  level  with 
the  reflected  action,  more  or  less  complete,  the 
thought  of  an  action  which  appears  important  and 
of  which  one  often  thinks,  determines  interroga- 
tions, doubts,  scruples.  If  the  individual  descends 
one  degree,  if  he  becomes  quite  incapable  of  reflect- 
ing and  therefore  of  doubting,  the  same  action 
he  continues  to  think  about  may  present  itself 
under  the  form  of  an  impulsion  more  or  less  irresist- 
ible. 

There  are  patients  who  in  the  first  stage  have  the 
fear  and  horror  of  committing  an  act  and  who  in  the 
second  stage  are  driven  to  accomplish  it.  In  other 
cases  a  subject  may  make  use  of  an  action  as  a  means 
of  exciting  and  raising  himself;  he  seeks  it,  and  the 
thought  of  this  action  is  accompanied  by  love  and 
desire.  Let  him  become  depressed  and  he  will  no 
longer  be  able  to  accomplish  this  same  action  with- 
out exhausting  himself;  he  is  then  reduced  to  dread 
it  and  take  an  aversion  to  it.  That  which  was  an 


NEUROSES    AND    PSYCHOSES 

object  of  love  becomes  an  object  of  hatred.  Thence 
these  turnings  of  mind  that  are  so  often  to  be  ob- 
served in  the  course  of  neuroses  and  psychoses.  In 
a  score  of  my  observations  the  frenzy  of  persecution 
and  hatred  presents  itself  as  an  evolution  of  those 
obsessions  of  love  and  domination. 

These  are  very  curious  facts  that  one  observes  in 
the  oscillations  of  the  mind,  in  particular  when  the 
psychasthenic  depression  becomes  more  serious  and 
transforms  itself  in  psychasthenic  delirium,  which 
is  more  frequent  than  one  generally  imagines.  As 
a  rule  the  properly  so-called  psychasthenic  has  only 
disorders  of  the  reflection;  he  doubts  but  he  does  not 
rave.  But  under  different  influences,  his  depression 
may  augment,  and  when  he  drops  below  reflection 
he  has  no  longer  the  doubts,  the  hesitations,  he  no 
longer  shows  manias  of  love  and  of  direction,  he 
transforms  his  obsessions  into  deliriums  and  often 
his  loves  into  hatreds. 

These  are  a  few  examples  of  the  perturbations  of 
conduct  common  to  neurotic  sufferers  and  the  dis- 
eased in  mind.  One  perceives  that  the  same  laws 
relating  to  the  diminution  of  force  and  the  lowering 
of  the  psychological  tension  intervene  in  the  same 
way  with  the  one  as  with  the  others.  The  distinctions, 
which  have  been  established  for  social  reasons  and 
practical  conveniences,  no  longer  exist  when  one 

[  139] 


A    PSYCHIATRIC    MILESTONE 

tries  to  find,  by  analysis  of  the  symptoms,  the  na- 
ture of  neuroses  and  psychoses. 

The  latter  reflection  shows  us,  however,  that  in 
certain  cases,  at  least,  there  is  a  certain  difference  in 
degree  between  neuroses  and  psychoses.  The  evo- 
lution of  the  human  mind  has  been  formed  by  de- 
grees, by  successive  stages,  and  we  possess  in  our- 
selves a  series  of  superposed  layers  which  correspond 
to  diverse  stages  of  the  psychological  development; 
when  our  forces  diminish  we  lose  successively  these 
diverse  layers  commencing  with  the  highest.  It  is 
the  superior  floors  of  the  buildings  that  are  reached 
first  by  the  bombardments  of  the  war  and  the  cellars 
are  not  destroyed  at  first;  they  acquire  even  more 
importance,  as  people  are  beginning  to  inhabit 
them.  Well,  according  as  the  depression  descends 
more  or  less  deeply,  the  disorders  which  result  from 
the  loss  of  the  superior  functions  and  the  exaggerated 
action  of  the  inferior  ones  become  more  and  more 
serious  and  are  appreciated  differently.  The  su- 
perior psychological  functions  are,  in  my  opinion, 
experimental  tendencies  and  rational  tendencies. 
They  are  tendencies  to  special  actions  in  which  man 
takes  in  account  remembrances  of  former  acts  and  of 
their  results,  in  which  he  enforces  on  himself  by  a 
special  effort  obedience  to  logical  and  moral  laws. 
A  little  fatigue  and  a  slight  degree  of  exhaustion  are 

[ 


NEUROSES   AND    PSYCHOSES 

sufficient  for  such  an  action  to  become  difficult  and 
impossible  to  prolong  for  a  long  time.  Furthermore, 
the  disorders  of  the  experimental  conduct  or  of  the 
rational  conduct  are  very  frequent.  These  dis- 
orders only  reach  the  superior  actions  which  are  not 
absolutely  necessary  to  the  conservation  of  social 
order.  They  can  be  easily  repaired  by  inferior  acts: 
if  the  man  does  not  obey  pure  moral  principles,  at 
least  he  can  conduct  himself  in  appearance  in  an 
analogous  manner  through  fear  of  the  prison.  Also, 
these  disorders  of  the  superior  functions  are  con- 
sidered as  slight;  they  are  called  errors,  or  faults, 
and  it  is  admitted  that  the  subjects  remain  normal 
beings. 

At  the  other  extremity  of  the  hierarchical  series 
of  tendencies  the  acts  are  simply  reflex.  When  the 
disease  descends  to  this  level,  when  the  elementary 
acts  can  no  longer  be  executed  correctly,  we  do  not 
hesitate  either,  and  we  consider  these  disorders 
(related  with  known  lesions)  as  organic  diseases  of 
the  nervous  system.  But  between  these  two  terms 
we  note  disorders  in  behavior  which  are  more  diffi- 
cult to  interpret.  These  disorders  are  too  grave 
and  too  difficult  to  modify  by  our  usual  processes  of 
education  and  punishment  for  us  to  consider  them  as 
mere  errors  or  as  moral  faults;  they  are  variable; 
they  are  not  accompanied  by  actually  visible  lesions 


A    PSYCHIATRIC   MILESTONE 

and  we  have  trouble  in  classing  them  among  the 
acknowledged  deteriorations  of  the  organism.  There 
is  the  province  of  neuroses  and  psychoses,  inter- 
medium between  that  of  rational  errors  and  that  of  or- 
ganic diseases  of  the  nervous  system.  It  corresponds 
to  the  disorders  of  medium  psychological  functions, 
to  the  group  of  these  operations  which  establish  a 
union  more  or  less  solid  between  the  language  and 
the  movements  of  limbs  and  which  give  birth  to  our 
wills  and  beliefs. 

Can  one  establish,  in  this  group,  a  distinction 
between  neuroses  and  psychoses  that  rests  on  some 
more  precise  notion  and  that  is  not  limited  to  dis- 
tinguishing them  in  a  legal  point  of  view  ?  A  more 
profound  knowledge  of  the  mechanisms  of  the  will 
and  belief  would  perhaps  permit  us  to  do  so.  We 
are  capable  of  wills  and  beliefs  of  a  superior  order 
when  we  reach  decision  after  reflection.  The  oper- 
ation of  reflection  which  hinders  tendencies  and 
maintains  them  in  the  shape  of  ideas,  which  com- 
pares ideas  and  which  only  decides  after  this  deliber- 
ation, constitutes  the  highest  form  of  the  medium 
operations  of  the  human  mind.  Lower,  still,  there 
exists  will  and  belief,  but  they  are  formed  without 
reflection,  without  stoppage  of  ideas,  without  de- 
liberation; they  are  the  result  of  an  immediate 
assent  which  transforms  verbal  formulas  into  wills 

[  142] 


NEUROSES    AND    PSYCHOSES 

and  beliefs  as  soon  as  they  strike  the  attention,  as 
soon  as  they  are  accompanied  by  a  powerful  senti- 
ment. The  immediate  assent  is  the  inferior  form  of 
these  tendencies. 

If  one  wished  to  establish  a  scientific  distinction 
between  neuroses  and  psychoses,  I  should  say,  in 
a  summary  fashion,  that  in  neuroses  the  reflection 
alone  is  disturbed,  that  in  psychoses  the  immediate 
assent  itself  is  affected.  The  shrinkage  of  the  con- 
science, doubts,  aboulias,  obsessions,  scruples  are 
always  disorders  of  the  reflected  will  and  belief.  On 
the  contrary,  irresistible  impulsions,  deliriums,  in- 
differences which  suppress  desires  and  only  allow 
elementary  agitations  to  subsist,  show  alterations  in 
the  immediate  assent,  in  the  will,  and  the  primitive 
belief  and  must  be  considered  as  psychoses.  Below 
could  be  placed  the  disorders  of  elementary  intelli- 
gence, the  disorder  of  the  perceptive  and  social 
functions  which  characterize  the  mental  deficiencies 
of  imbeciles  and  idiots.  One  might  also  distinguish 
these  disorders  according  to  the  degree  of  depth  the 
destruction  of  the  edifice  has  reached,  according  to 
the  more  or  less  distant  state  of  evolution  to  which 
the  patient  goes  back.  But  these  psychological 
classifications  are  purely  theoretical,  and  in  prac- 
tice many  other  factors  intervene  which  oblige  us 
to  consider  such  a  patient  as  incapable  of  doing  any 

[143] 


A    PSYCHIATRIC    MILESTONE 

harm  and  such  another  as  dangerous;  this  is  the  only 
difference  to-day  between  neuroses  and  psychoses. 
Later  on,  without  doubt,  we  shall  be  able  to  sub- 
stitute for  these  simply  symptomatical  and  psy- 
chological diagnostics,  some  etiological  and  physio- 
logical diagnostics.  We  shall  be  able  from  the  very 
outset  to  recognize  that  a  disorder,  in  all  appearance 
slight  and  which  is  not  deeply  set,  presents  a  bad 
prognosis,  and  we  shall  be  able  to  foresee  a  serious 
and  deep  psychosis  in  the  future.  To-day,  without 
doubt,  one  can  often  distinguish  from  the  outset 
the  future  general  paralytic  from  the  simple  neuras- 
thenic. But  in  the  actual  state  of  science  this  abil- 
ity to  distinguish  is  not  frequent  and  the  future 
evolution  of  a  depressed  state  can  scarcely  be  fore- 
seen with  precision. 

Certain  individuals  pass  in  a  few  years  from  psy- 
chasthenic  depression  with  doubts  and  obsessions  to 
psychasthenic  deliriums  with  stubbornness  and  nega- 
tivism, then  to  asthenic  insanity  with  irremediable 
and  complete  want  of  power.  Is  it  necessary  to  say 
that  we  made  a  mistake  in  our  diagnostic  and  that 
from  the  first  demential  psychosis  should  have  been 
recognized  ?  I  am  not  convinced  of  this :  these  dis- 
eases, excepting  a  few  cases  with  rapid  evolution, 
are  not  characterized  from  the  outset.  Without 
doubt  we  must  note  that  these  depressions  which 
disturb  the  reflective  tendencies  of  young  patients  in 

[  144] 


NEUROSES   AND    PSYCHOSES 

full  period  of  formation,  are  dangerous  and  can  bring 
on  still  deeper  depressions  of  the  psychological 
tension.  But  that  evolution  is  rarely  fatal;  it  can 
very  often  be  checked,  and  it  seems  to  me  fair  to 
preserve  the  distinction  between  neuroses  and  psy- 
choses considered  as  different  degrees  of  psychologi- 
cal decadence. 

Neuroses  are,  therefore,  the  intermedium  between 
the  errors  and  the  faults  which  appeared  to  us  al- 
most normal,  and  alienation  which  seemed  excep- 
tional and  distant  from  us.  The  first  appearances  of 
that  depression  which  in  a  continuous  manner  de- 
scends to  alienation  are  to  be  found  already  in  the 
disorders  of  character  which  seemed  to  be  quite 
insignificant.  The  miser,  the  misanthrope,  the  hypo- 
crite are  described  by  the  writer  before  they  are 
claimed  by  the  physician.  A  great  number  of 
neuropathic  disorders  which  I  have  described  are 
related  to  the  popular  type  of  mother-in-law.  This 
type  is  not  necessarily  that  of  a  woman  whose 
daughter  has  married,  but  the  type  of  a  depressed 
woman  of  about  fifty,  aboulic,  discontented  with 
herself  and  others,  domineering,  and  jealous,  be- 
cause she  suffers  from  the  mania  of  being  loved 
though  she  is  incapable  of  acquiring  any  one's  affec- 
tion. All  exhaustions,  all  moral  failings  have  the 
closest  connection  with  neuroses  and  psychoses. 

These   reflections   prove   to  us  that  the   alienist 


A    PSYCHIATRIC    MILESTONE 

physician  should  interest  himself  more  and  more  in 
the  treatment  of  neuroses  even  slight,  to  rectifying 
the  disorders  of  temper,  to  the  education  of  the 
young,  to  the  direction  of  the  moral  hygiene  of  his 
country.  On  many  of  these  points  America  leads 
the  way;  your  works  of  social  hygiene,  the  good 
battle  you  are  fighting  against  alcoholism,  are  exam- 
ples for  us.  You  are  the  new  world,  younger,  not 
rendered  so  inactive  by  secular  habits.  You  can 
act  more  easily  than  we.  We  may  have  the  advan- 
tage, in  the  old  world,  of  the  experience  of  old  people 
and  the  habit  of  observation,  but  we  are  slack  in 
reform  and  action.  "If  youth  had  experience  and 
old  age  ability,"  says  one  of  our  proverbs.  We  must 
remain  united  and  join  your  strength  to  our  experi- 
ence for  the  greater  progress  of  the  studies  which 
are  dear  to  us  and  for  the  greater  good  benefit  of 
our  two  countries. 


ADDRESS      BY 

DR.    WILLIAM    L.     RUSSELL 


The  Chairman:  The  year  1921  is  rich  in  anni- 
versaries for  the  New  York  Hospital.  Next  October 
we  plan  to  celebrate  the  one  hundred  and  fiftieth 
anniversary  of  the  granting  of  our  charter.  To-day 
we  are  occupied  with  the  Bloomingdale  Centenary. 
A  fortnight  ago  the  twenty-fifth  annual  graduating 
exercises  of  our  Training  School  for  Nurses  were 
held  in  this  room.  This  year  also  marks  the  decen- 
nial of  Dr.  Russell's  term  of  office  as  Medical  Super- 
intendent. When  his  devoted  predecessor,  Dr.  Sam- 
uel B.  Lyon,  asked  in  1911  to  be  relieved  from  active 
duty  and  became  our  first  Medical  Superintendent 
Emeritus,  we  were  most  fortunate  in  securing  as  his 
successor  Dr.  Russell.  Coming  to  this  institution 
after  a  broad  psychiatric  and  administrative  experi- 
ence, he  has  taken  up  our  special  problems  with  deep 
insight  and  gratifying  success.  He  has  selected  for 
his  subject  this  afternoon  "THE  MEDICAL  DEVELOP- 
MENT OF  BLOOMINGDALE  HOSPITAL."  No  one  can 
speak  with  greater  authority  on  a  theme  of  which 
it  may  be  said  quorum  magna  pars — fortunately  not 
only  fuit — but  est  and  erit  as  well. 


DR.   RUSSELL 

The  object  of  this  celebration  is  not  merely  to 
glorify  the  past  and  least  of  all  is  it  to  laud  the 
present.  What  we  hope  from  it  is  that  it  will  es- 
tablish a  milestone,  not  only  to  mark  the  progress 
thus  far  made  but  to  point  the  way  to  a  path  of 
greater  usefulness.  The  advances  in  medical  sci- 
ence and  practice  and  in  the  specialty  of  psychiatry 
during  the  past  hundred  years  fill  one  with  wonder 
and  hope.  It  is  worth  while  to  review  them  merely 
to  obtain  this  help.  The  outlook  for  the  century  to 
come  is,  however,  so  far  as  can  be  anticipated,  still 
brighter. 

To  review  the  past  is,  at  a  time  like  this,  not  un- 
profitable. It  may  prevent  us,  in  our  zeal  for  the 
new,  from  discarding  what  is  valuable  in  the  old, 
and  from  overvaluing  some  things  which  may  have 
outlived  their  usefulness.  We  must  be  careful  that 
we  do  not  fall  into  errors  similar  to  those  from  which 
the  medical  profession  was  rescued  by  the  movement 
of  which  Bloomingdale  Asylum  was  an  offspring. 
It  should  be  recalled  that  the  establishment  of  the 
asylum  was  due  to  the  initiative  of  the  Governors  of 
the  New  York  Hospital,  especially  Mr.  Eddy,  rather 


A    PSYCHIATRIC    MILESTONE 

than  to  the  active  interest  and  direction  of  physicians. 
The  object  of  the  establishment  was,  according  to 
Mr.  Eddy,  to  afford  an  opportunity  of  ascertaining 
how  far  insanity  may  be  relieved  by  moral  treatment 
alone,  which,  he  says,  "it  is  believed,  will,  in  many 
instances,  be  more  effective  in  controlling  the  mani- 
acs than  medical  treatment."  The  moral  manage- 
ment he  referred  to,  though  advocated  by  Pinel  and 
a  few  others,  some  of  whom  were  benevolent  and 
intelligent  laymen,  had  not  been  accepted  by  physi- 
cians as  a  distinct  form  of  medical  treatment.  Few 
physicians  of  the  period  had  accepted  management 
of  the  mind  as  described  and  practised  by  Pinel  as 
being  a  distinct  medical  procedure,  as  having  the 
same  value  in  overcoming  mental  disorders  as  the 
drastic  medical  remedies  which  they  were  accustomed 
to  employ,  or  as  having  any  exclusive  healing  power. 
This  is  clearly  shown  by  the  case  records  of  the  men- 
tal department  of  the  New  York  Hospital  which  have 
been  preserved  since  1817,  and  of  those  of  Blooming- 
dale  Asylum  for  some  years  after  its  opening  in 
1821.  It  is  plainly  set  forth  in  Dr.  Rush's  book  on 
diseases  of  the  mind,  which  was  first  published  in 
1810  and  again  in  a  fourth  edition  in  1830.  Rush 
was  physician  to  the  Pennsylvania  Hospital  and  his 
book  was  the  principal,  if  not  the  only,  one  of  the 
period  by  an  American  author.  American  physi- 


DEVELOPMENT   OF    HOSPITAL 

cians  like  their  European  brothers,  had,  as  Pinel 
observes,  "allowed  themselves  to  be  confined  within 
the  fairy  circle  of  antiphlogisticism,  and  by  that 
means  to  be  deviated  from  the  more  important 
management  of  the  mind."  Rush  believed  that 
madness  was  a  disease  of  the  blood-vessels  of  the 
brain  of  the  same  nature  as  fever,  of  which  it  was  a 
chronic  form.  "There  is,"  he  says,  "not  a  single 
symptom  that  takes  place  in  an  ordinary  fever, 
except  a  hot  skin,  that  does  not  occur  in  an  acute 
attack  of  madness."  He  found  in  his  autopsy 
observations  confirmation  of  this  view  and  concludes 
that  "madness  is  to  phrenitis  what  pulmonary  con- 
sumption is  to  pneumony,  that  is,  a  chronic  state 
of  an  acute  disease."  The  reason  for  believing  that 
madness  was  a  disease  of  the  blood-vessels,  which 
seemed  to  him  most  conclusive,  was  "from  the  reme- 
dies which  most  speedily  and  certainly  cure  it  being 
exactly  the  same  as  those  which  cure  fever  or  disease 
in  the  blood-vessels  from  other  causes  and  in  other 
parts  of  the  body."  The  treatment  he  recommended 
and  which  was  generally  employed  was  copious 
blood-letting,  blisters,  purges,  emetics,  and  other 
severe  depleting  measures.  When  Bloomingdale 
Asylum  was  established,  therefore,  the  provision  for 
moral  treatment  did  not  contemplate  that  this 
should  be  applied  by  the  physician  or  that  he  should 


A    PSYCHIATRIC    MILESTONE 

have  full  control  of  the  resources  by  means  of  which 
it  could  be  applied.  The  records  do  not  indicate 
that  either  the  physicians  or  the  Governors  realized 
that  this  might  be  necessary  or  advantageous.  The 
present  system  of  administration  in  which  the  chief 
physician  is  also  the  chief  executive  officer  of  the 
institution  was  a  result  of  an  evolution  which  took 
many  years  to  reach  its  full  consummation. 

Pinel,  many  years  before  Bloomingdale  Asylum 
was  opened,  had  shown  by  the  most  careful  observa- 
tion and  practice  that  the  management  and  disci- 
pline of  the  hospital  was  a  most  powerful  agent  in 
the  treatment  of  the  patients.  The  manner  in 
which  he  was  led  to  this  conclusion  is  a  remarkable 
example  of  the  scientific  method.  When  he  became 
physician  to  the  Bicetre  he  found  that  the  methods 
of  classification  and  treatment  recommended  in  the 
books  seemed  to  be  inadequate,  and,  desiring  further 
information,  he  says:  "I  resolved  to  examine  myself 
the  facts  which  were  presented  to  my  attention; 
and,  forgetting  the  empty  honor  of  my  titular  dis- 
tinction as  a  physician,  I  viewed  the  scene  that 
opened  to  me  with  the  eye  of  common  sense  and 
unprejudiced  observation.  .  .  .  From  systems  of 
nosology,  I  had  little  assistance  to  expect;  since  the 
arbitrary  distributions  of  Sauvages  and  Cullen  were 
better  calculated  to  impress  the  conviction  of  their 


DEVELOPMENT   OF    HOSPITAL 

insufficiency  than  to  simplify  my  labor.  I,  there- 
fore, resolved  to  adopt  that  method  of  investigation 
which  has  invariably  succeeded  in  all  the  depart- 
ments of  natural  history,  viz.,  to  notice  successively 
every  fact,  without  any  other  object  than  that  of 
collecting  materials  for  future  use;  and  to  endeavor, 
as  far  as  possible,  to  divest  myself  of  the  influence, 
both  of  my  own  prepossessions  and  the  authority 
of  others.  With  this  view,  I  first  of  all  took  a  general 
statement  of  the  symptoms  of  my  patients.  To 
ascertain  their  characteristic  peculiarities,  the  above 
survey  was  followed  by  cautious  and  repeated  ex- 
aminations into  the  condition  of  individuals.  All 
our  new  cases  were  entered  at  great  length  upon  the 
journals  of  the  house."  Having  thus  studied  care- 
fully the  course  of  the  disease  in  a  number  of  patients 
who  were  subjected  only  to  the  guidance  and  con- 
trol made  possible  by  the  management  of  the  hos- 
pital under  the  direction  of  a  remarkably  highly 
qualified  Governor,  it  came  to  him  with  the  force  of  a 
new  discovery  that  this  man  who  was  not  a  physician 
was  doing  more  for  the  patients  than  he  was,  and 
that  insanity  was  curable  in  many  instances  by  mild- 
ness of  treatment  and  attention  to  the  state  of  mind 
exclusively.  "I  saw  with  wonder,"  he  says,  "the 
resources  of  nature  when  left  to  herself,  or  skilfully 
assisted  in  her  efforts.  My  faith  in  pharmaceutic 


A    PSYCHIATRIC   MILESTONE 

preparations  was  gradually  lessened,  and  my  scepti- 
cism went  at  length  so  far  as  to  induce  me  never  to 
have  recourse  to  them,  until  moral  remedies  had 
completely  failed."  So  convinced  did  he  become  of 
the  significance  and  importance  of  the  management 
and  discipline  of  the  hospital  in  the  treatment  of 
the  patients,  that,  when  a  few  years  later,  he  wrote 
his  "Treatise  on  Insanity,"  he  states  that  one  of  the 
objects  of  his  writing  it  was,  "to  furnish  precise 
rules  for  the  internal  police  and  management  of 
charitable  establishments  and  asylums;  to  urge  the 
necessity  of  providing  for  the  insulation  of  the  differ- 
ent classes  of  patients  at  houses  intended  for  their 
confinement;  and  to  place  first,  in  point  of  conse- 
quence, the  duties  of  a  humane  and  enlightened 
superintendency  and  the  maintenance  of  order  in 
the  services  of  the  Hospitals." 

Pinel's  views  had  apparently  not  been  fully  under- 
stood or  adopted  by  the  physicians  of  America  at 
the  time  Bloomingdale  Asylum  was  planned  and 
established.  Dr.  Rush  did  not  mention  him  in  his 
book,  and  Mr.  Eddy,  in  his  communication  to  the 
Governors  of  the  New  York  Hospital,  referred  only 
to  the  writings  of  Drs.  Creighton,  Arnold,  and 
Rush  and  the  Account  of  the  York  Retreat  by  Sam- 
uel Tuke. 

When  Bloomingdale  Asylum  was  opened,  the  form 


DEVELOPMENT    OF    HOSPITAL 

of  organization  introduced  was  that  under  which  the 
department  at  the  New  York  Hospital  had  been 
conducted.  Mr.  Laban  Gardner  was  made  Superin- 
tendent or  Warden  with  two  men  and  three  women 
keepers  to  aid  him  in  the  control  and  management 
of  the  seventy-five  patients.  There  was  an  Attending 
Physician  who  visited  once  a  week  and  a  Resident 
Physician,  neither  of  whom  received  salaries.  There 
is  nothing  in  the  records  to  indicate  that  in  the  be- 
ginning, the  Governors  of  the  Hospital  looked  upon 
the  moral  treatment  of  the  patients,  which  was  the 
object  for  which  the  institution  was  established,  as 
the  task  of  the  Physicians.  The  aim  was  to  furnish 
employment,  diversion,  discipline,  and  social  en- 
joyment, without  much  attempt  at  precision  or  close 
medical  direction  and  control.  For  a  time  the  re- 
sults were  considered  to  be  satisfactory.  In  1824, 
however,  a  joint  Committee  of  the  Board  reported 
that  they  were  impressed  by  the  necessity  of  improv- 
ing the  moral  treatment,  and  recommended  that  two 
discreet  persons  be  appointed  to  take  charge  of  such 
of  the  patients  as  might  from  time  to  time  be  in  a 
condition  to  be  amused  or  employed  on  the  farm  or 
in  walking  exercises  in  the  open  or  in  classes  to  be 
designated  by  the  Resident  Physician  "with,"  how- 
ever, "the  approbation  of  the  Superintendent,"  who 
you  will  recall  was  not  a  physician.  These  patients 


A    PSYCHIATRIC    MILESTONE 

were,   the   report   recommends,   to   be   particularly 
under  the  charge  of  the  Resident  Physician  when  thus 
employed  or  amused  "out  of  the  Asylum."     At  this 
time,  the  Attending  and  Resident  Physicians  were 
placed  on  a  small  salary,  and  the  Resident  Physician 
was  instructed  to  "devote  a  greater  portion  of  his 
time  and  attention  to  the  moral  part  of  the  establish- 
ment and  to  communicate  to  the  Committee  such 
improvements  as  his  experience  shall  suggest  to  be 
useful  and  necessary  in  carrying  into  more  complete 
effect  the  system  of  moral  treatment  and  to  report 
from  time  to  time  to  the  Committee  the  effect  of 
the  measure  adopted."     This  seems  to  have  been 
the  beginning  of  a  realization  that  the  moral  manage- 
ment of  the  patients  was  inseparable  from  medical 
treatment  and  must  necessarily  be  the  task  of  the 
physician.     Seven   years    after   this,    in    1831,    the 
Committee  found  it  advisable  to  spread  upon  the 
minutes  an  "interpretation  and  regulations,"  relat- 
ing to  the  Superintendent  and  Matron  of  the  Asylum 
and  to  the  Asylum  physicians,  to  the  effect  that  the 
Committee  understood  that  the  regulations  "placed 
the  moral  treatment  on  the  physician  alone,  under 
the  direction  of  the  Asylum  Committee,  and  that 
the  responsibility  remains  with  him  alone,  that  this 
treatment  commenced  with  the  reception  of  the  pa- 
tient, the  ward  where  he  shall  be  placed,  his  exercises, 

[158] 


DEVELOPMENT   OF    HOSPITAL 

amusement,  admission  of  friends,  the  time  of  dis- 
charge from  the  house.  .  .  .  And  that  all  orders 
to  nurses  and  keepers  which  the  physicians  may  think 
necessary  to  carry  these  orders  into  effect  shall 
be  communicated  through  the  Superintendent"  (or 
Warden).  In  1832,  the  Resident  Physician,  Dr. 
James  Macdonald,  who  had  just  returned  from  Eu- 
rope after  having  spent  a  year  in  visiting  the  insti- 
tutions for  mental  disorders  there,  made  a  report  in 
which  he  rather  significantly  referred  to  the  impracti- 
cability of  making  a  sharp  distinction  between  the 
medical  and  moral  treatment  of  the  patients,  it 
being  difficult  to  say  where  the  one  ended  and  the 
other  began,  or  to  put  one  into  successful  operation 
without  bringing  in  the  other.  At  this  time  the 
position  of  Attending  Physician  was  abolished  and 
the  Resident  Physician  was  made  the  Chief  Medical 
Officer  of  the  Asylum.  It  was  not  until  1837  that 
an  amendment  to  the  by-laws  regulating  the  powers 
of  the  physician  and  the  Warden  was  adopted  which 
gave  to  the  physician  the  power  of  appointing  and 
discharging  at  pleasure  all  the  attendants  on  the 
patients,  while  to  the  Warden  was  reserved  the  power 
of  appointing  and  dismissing  all  other  employees. 
Fourteen  years  had  thus  elapsed  since  the  opening 
of  the  Asylum  before  the  physician  was  given  con- 
trol of  even  the  nursing  service.  The  first  Annual 

[159] 


A    PSYCHIATRIC   MILESTONE 

Report  of  the  Resident  Physician  of  the  Asylum  to 
be  published  appeared  in  1842.  In  this,  Dr.  William 
Wilson  makes  a  general  statement  in  regard  to  the 
beneficial  effects  of  the  moral  as  well  as  the  medical 
treatment  pursued  in  the  institution,  and  refers 
particularly  to  occupations,  exercise  in  the  open  air, 
amusement,  religious  services,  and  he  asks  that  a 
workshop  be  erected  for  the  men.  It  is  evident  that 
by  this  time  the  authority  of  the  physician  in  the 
management  of  the  institution  had  been  extended 
and  it  is  perhaps  significant  that  in  his  report  of 
the  following  year  Dr.  Wilson  refers  to  a  plan  for 
distribution  of  food  which  had  been  evolved  in  co- 
operation with  the  Warden.  Under  the  direction  of 
Dr.  Pliny  Earle,  who  was  appointed  physician  to  the 
Asylum  in  1844,  treatment  directed  to  the  mind 
was  further  elaborated  and  systematized,  and  the 
place  of  the  physician  in  the  management  of  the 
hospital  was  more  firmly  established. 

This  brief  survey  indicates  how,  in  the  develop- 
ment of  the  work  of  the  institution,  it  required  years 
of  practical  experience  to  show  to  the  Governors 
that,  in  order  to  secure  for  the  patients  the  treat- 
ment which  the  Asylum  had  been  established  to 
furnish,  it  was  necessary  to  extend  the  powers  and 
duties  of  the  physician  so  that  he  could  control 
and  direct  the  internal  management  and  discipline, 

[160] 


DEVELOPMENT   OF    HOSPITAL 

and  all  the  resources  for  social  as  well  as  individual 
treatment.  This  extension  was  continued  until 
finally  the  present  form  of  organization  was  adopted 
in  which  the  chief  physician  is  also  the  chief  execu- 
tive officer  of  the  institution.  This  was,  however, 
not  fully  accomplished  until  1877.  It  is  now  uni- 
versally recognized  that  the  physician  must  be  the 
supreme  head  of  the  organization,  and  all  American 
institutions  and  most,  if  not  all,  of  those  in  other 
countries  are  now  similarly  organized. 

In  the  early  development  of  Bloomingdale  Asylum, 
this  extension  of  the  influence  and  authority  of  the 
physician  is  the  outstanding  medical  fact.  It  did 
away  with  division  of  responsibility  and  removed 
from  discussion  the  question  of  moral  as  distinct 
from  medical  treatment.  Thereafter  a  harmonious 
and  effective  application  of  all  the  resources  of  the 
institution  to  the  problems  of  the  patients  became 
more  easily  and  certainly  possible.  Since  then,  the 
resources  for  treatment  directed  to  the  mind  have 
been  developed  as  steadily  and  fully  as  those  re- 
quired for  the  treatment  of  physical  conditions. 
The  use  of  the  organized  agencies  which  were  re- 
garded by  the  founders  as  the  main  reliance  in  moral 
treatment,  namely  occupations,  physical  exercises 
and  games,  diversion,  social  contacts,  and  enjoy- 
ment, and  management  of  behavior  has  been  greatly 

[161] 


A    PSYCHIATRIC    MILESTONE 

extended,  and  specialized  departments  have  been 
created  for  their  application  with  system  and  growing 
precision.  Great  advances  have  also  been  made  in 
the  methods  of  examining  the  minds  of  the  patients 
and  of  determining  the  mental  factors  in  their  dis- 
orders and  the  means  of  restoring  their  capacity  for 
adjustment  to  healthy  thinking  and  acting.  Psy- 
chiatry has  been  furnished  with  a  body  of  well-ar- 
ranged facts,  and  with  a  technic  which  is  not  in- 
ferior in  system  and  precision  to  that  of  many  other 
branches  of  medicine.  In  the  study  and  manage- 
ment of  the  minds  of  the  patients  the  physician  is 
thus  enabled  to  apply  himself  to  the  task  as  he  does 
to  any  other  medical  problem. 

The  advances  in  general  medical  science  and  prac- 
tice have  also  necessitated  great  elaboration  of  the 
resources  for  the  study  and  treatment  of  the  physical 
condition  of  the  patients.  Instruments  of  precision, 
laboratories,  x-ray  departments,  dental  and  surgical 
operating  rooms,  massage  and  hydrotherapy  de- 
partments, facilities  for  eye,  throat,  nose,  and  ear 
examinations  and  treatment,  and  all  the  other  means 
of  determining  disease  processes  and  applying  proper 
treatment  have  been  supplied  and  the  methods  and 
standards  of  modern  clinical  medicine  and  surgery 
are  utilized.  It  can  now  be  clearly  seen  that  it  is 
necessary  to  direct  attention  to  the  whole  personality 


DEVELOPMENT   OF    HOSPITAL 

of  the  patient,  including  his  original  physical  and 
mental  constitution,  the  physical  as  well  as  the  men- 
tal factors  which  may  be  operating  to  produce  his 
disorder,  and  the  environmental  conditions  to  which 
he  has  been  and  may  again  be  exposed.  In  the  treat- 
ment of  mental  disorders  it  is  necessary  to  beware  of 
what  Pinel  found  to  be  the  fault  of  the  physicians 
and  medical  authors  of  his  time,  who  he  says  were 
more  concerned  with  the  recommendation  of  a  favor- 
ite remedy  than  with  the  natural  history  of  the  dis- 
ease, "as  if,"  he  says,  "the  treatment  of  every  dis- 
ease without  accurate  knowledge  of  its  symptoms  in- 
volved in  it  neither  danger  nor  uncertainty,"  and 
he  quotes  the  following  maxim  of  Dr.  Gault:  "We 
cannot  cure  diseases  by  the  resources  of  art,  if  not 
previously  acquainted  with  their  terminations,  when 
left  to  the  unassisted  efforts  of  nature."  Exclusive 
attention  to  the  physical  condition  and  factors,  or  to 
the  mental  condition  and  factors,  or  concentration 
on  one  theory  or  one  form  of  treatment  to  the  ex- 
clusion of  all  others  is  sure  to  lead  to  neglect  of  that 
careful  general  inquiry  into  the  whole  personality  of 
the  patient,  into  the  conditions  out  of  which  his  dis- 
order arose,  and  into  all  the  manageable  factors 
in  the  situation  which  is  so  essential  to  intelligent 
and  effective  treatment.  Notwithstanding  the  great 
benefit  which  has  been  derived  from  physical  mea- 


A    PSYCHIATRIC   MILESTONE 

sures  in  the  study  and  treatment  of  mental  disorders, 
and  the  well-founded  hopes  of  greater  advances  in 
this  direction,  the  main  task  still  continues  to  be  what 
Pinel  calls  the  management  of  the  mind.  Experience 
and  increasing  knowledge  show  that  this  is  a  task 
which  can  only  be  successfully  performed  by  the 
physician  and  by  means  of  organized  resources  which 
are  under  medical  direction  and  control.  The  hospi- 
tal for  mental  disorders  furnishes  the  means  of  pro- 
viding social  as  well  as  individual  treatment.  It  is 
a  medical  mechanism  and  for  its  proper  manage- 
ment and  use  it  is  required  of  physicians  that  they 
accept  the  burden  of  much  executive  work  and  give 
their  attention  to  many  subjects  and  activities  that 
may  interfere  seriously  with  what  they  have  been 
taught  to  regard  as  more  strictly  professional  inter- 
ests. Like  Pinel,  one  must  be  willing  to  forget  the 
empty  honor  of  one's  titular  distinction  as  a  phy- 
sician, and  do  whatever  may  be  necessary  to  make 
the  institution  a  truly  medical  agency  for  the  heal- 
ing of  the  sick.  Considerable  progress  has  been 
made  in  developing  executive  assistants  to  relieve 
the  physicians  of  much  of  the  administrative  work 
which  requires  little  or  no  medical  supervision  and 
direction.  Special  provision  for  the  training  of  such 
executives  has,  however,  received  insufficient  atten- 
tion. This  question  might,  with  great  advantage, 


DEVELOPMENT   OF    HOSPITAL 

be  taken  up  by  the  hospitals  and  colleges.  Nothing 
would  add  more  to  the  quality  of  the  service  which 
the  hospitals  render  than  to  supplement  the  work  of 
the  physicians  by  that  of  well  educated  and  highly 
trained  executive  assistants  who  would  themselves 
find  an  extremely  interesting  and  productive  field  for 
their  efforts. 

A  period  has  now  been  reached  in  this  field  of  work 
when  what  amounts  to  a  movement  not  inferior  in 
significance  and  importance  to  that  of  a  hundred 
years  ago,  seems  to  be  in  active  operation.  The 
character  and  scope  of  this  movement  and  the  lines 
of  its  progress  have,  to  some  extent,  been  indicated 
in  the  illuminating  formulations  which  have  been 
presented  here  to-day.  The  medical  study  and  treat- 
ment of  the  mind  is  no  longer  so  exclusively  confined 
within  the  walls  of  institutions  nor  to  the  type  or 
degree  of  disorder  which  necessitates  compulsory  se- 
clusion. Psychiatry  is  extending  out  from  the  insti- 
tutions into  the  communities  by  means  of  out- 
patient clinics  and  social  workers,  through  newly 
created  organized  agencies,  through  informed  indi- 
viduals, physicians,  nurses,  and  lay  workers,  and 
through  the  general  spread  of  psychiatric  knowledge. 
This  process  is  being  expedited  by  the  efforts  of 
organized  bodies  such  as  the  National  and  State 
Committees  and  Societies  for  Mental  Hygiene,  and 


A    PSYCHIATRIC    MILESTONE 

the  public  is  rapidly  learning  what  can  properly  be 
expected  of  institutions,  officials,  physicians,  nurses, 
and  other  responsible  individuals  in  whom  special 
knowledge  and  ability  are  supposed  to  be  found. 
As  in  the  prevention  of  tuberculosis,  so,  in  the  pre- 
vention of  mental  disorders,  the  informed  public  is 
likely  to  start  a  campaign  which  the  medical  profes- 
sion may  have  to  make  haste  to  follow  in  order  to 
maintain  its  needed  leadership.  Although  much  is 
yet  required  to  improve  the  facilities  necessary  in 
carrying  on  the  present  work,  it  seems  to  us  that 
at  such  a  time  a  further  extension  of  the  activities 
of  an  institution  such  as  Bloomingdale  Hospital  may 
be  necessary  to  enable  it  to  fulfil  its  possibilities 
for  greater  usefulness.  To  extend  the  work  our  ex- 
perience indicates  that  a  department  in  the  city  at 
the  General  Hospital  would  be  of  great  advantage. 
During  the  past  few  years  the  oversight  of  discharged 
patients  has  grown  to  such  an  extent  that  it  seems  as 
though  some  organized  method  of  carrying  it  on  may 
soon  become  necessary.  This  and  out-patient  work 
generally  could  be  best  attended  to  in  a  city  depart- 
ment. Much  emergency  work  and  preliminary  ob- 
servation and  the  treatment  of  certain  types  of  cases 
now  frequently  subjected  to  unfortunate  delays, 
neglect,  and  unskilful  treatment  would  also  be  thus 
provided  for.  It  can  be  seen  too  that  developments  in 

[166] 


DEVELOPMENT   OF    HOSPITAL 

construction  and  organization  which  would  furnish 
organized  treatment  for  types  of  disorders  which  are 
not  so  incapacitating  as  the  pronounced  psychoses 
might  be  of  advantage  in  the  treatment  of  both  adults 
and  children.  The  property  on  which  the  Hospital 
is  located  is  large  enough  to  permit  of  further  exten- 
sions and  developments  which  could  be  as  closely 
connected  with,  or  as  widely  separated  and  dis- 
tinguished from,  the  present  provision  as  circum- 
stances required.  In  this  way  much  needed  pro- 
vision for  the  treatment  of  persons  suffering  from  the 
psychoneuroses  and  minor  psychoses  could  be  fur- 
nished. Better  provision  for  a  further  period  of  read- 
justment after  a  patient  is  ready  to  leave  the  Hospital 
but  not  yet  ready  to  face  the  risk  of  ordinary  condi- 
tions in  the  community  is  a  felt  want.  A  group  of 
supervised  homes  or  an  occupational  colony  might 
best  serve  this  purpose.  The  more  extensive  use 
of  the  Hospital  as  a  teaching  centre  is  also  a  subject 
for  consideration.  A  School  for  Nurses  is  now 
conducted,  and  much  instruction  is  given  in  the 
occupational  departments.  More,  however,  could 
be  done,  especially  in  medical  teaching,  which  could 
be  best  carried  on  in  a  department  in  the  city  and 
would  tend  to  advance  the  standard  of  medical  ser- 
vice throughout  the  Hospital. 

The  lines  of  further  development  are,   perhaps, 


A    PSYCHIATRIC    MILESTONE 

not  yet  perfectly  clear  in  all  directions.  It  seems 
certain,  however,  that  they  will  lead  toward  a  broader 
field  of  usefulness,  in  which  the  hospital  will  be  re- 
garded as  a  responsible  agency  for  dealing  with 
psychiatric  problems  in  the  community  which  it 
serves  and  will  take  part  with  other  agencies  in 
extending  psychiatric  knowledge  and  in  applying 
it  to  prevention,  and  to  the  management  of  mental 
disorders  as  an  individual  and  social  problem  be- 
yond the  walls  of  the  institution.  We  hope  that  this 
meeting  will  prove  a  real  starting  point  for  this 
development.  We  are  greatly  indebted  to  those  who 
have  taken  part  in  it  both  as  speakers  and  as  audi- 
ence. We  are  especially  indebted  to  those  who  came 
across  the  sea  to  be  with  us.  It  is  peculiarly  fitting 
that  representatives  of  France  and  of  England  should 
have  been  here,  for  to  Pinel,  the  Frenchman,  and  to 
Tuke,  the  Englishman,  are  due  more  than  to  any 
others  whose  names  we  know  the  foundations  of 
the  modern  institutional  treatment  of  mental  dis- 
orders. 


[168] 


The  Chairman :  This,  ladies  and  gentlemen,  con- 
cludes our  exercises.  As  the  representative  of  the 
Governors,  I  find  it  quite  impracticable,  in  supple- 
menting what  Dr.  Russell  has  just  said,  to  express 
adequately  our  admiration  of  and  gratitude  to  these 
eminent  scientists  and  apostles  of  light  for  their 
presence  here  and  for  their  inspiring  addresses. 
These,  if  I  may  be  permitted  to  appraise  them,  seem 
to  make  a  notable  addition  to  medical  literature, 
and,  with  the  permission  of  their  authors,  we  purpose, 
for  our  own  gratification  and  for  the  benefit  of  the 
profession,  to  have  all  of  the  addresses  preserved  in  a 
volume  recording  this  centenary  celebration.  In 
due  course  a  copy  of  this  volume  will  be  sent  to  each 
of  our  guests.  The  celebration  itself,  I  think  you 
will  all  agree  with  me,  has  been  a  moving  one,  with 
an  underlying  note  of  philanthropic  endeavor  as 
high  as  the  stars.  You  heard  its  refrain  in  the  pag- 
eant on  the  lawn  this  afternoon.  As  I  have  listened 
to-day  to  these  words  of  profound  wisdom,  uttered 
in  so  noble  a  spirit  of  human  ministry,  my  mind 
has  gone  back  to  the  sentence  from  Cicero's  plea  for 
Ligarius,*  which  formed  the  text  for  Dr.  Samuel 

*  Homines  enim  ad  Decs  nulla  re  proprius  accedunt,  quam  salutem 
hominibus  dando. 


THE    TABLEAU-PAGEANT 


S  YNO  P  S  I  S 


While  the  Symbolic  Father  Time  bears  witness, 
the  Muse  of  History,  as  the  Narrator,  after  alluding 
to  the  remote  past,  briefly  summarizes  the  incidents 
leading  up  to  the  establishment  of  the  Society  of  the 
New  York  Hospital  by  Royal  Charter  in  1771. 
The  succeeding  scenes  are  self-revealing.  The  fa- 
miliar picture  of  Pinel  at  Salpetriere  depicts  condi- 
tions in  that  period.  Several  portraits  of  personali- 
ties intimately  associated  with  the  early  history  of 
Bloomingdale  Hospital  follow.  These,  together  with 
an  episode  from  the  life  of  Dorothy  Dix,  stimulate 
our  imagination  with  reference  to  the  revival  of 
interest  in  the  care  of  the  mentally  ill  in  the  first 
half  of  the  last  century.  The  closing  scenes  suggest 
the  great  advance  which  has  taken  place  during  the 
century,  and  the  part  that  work  and  play  take  to-day 
in  re-establishing  and  maintaining  life's  balances. 
Finally,  in  symbolic  processional,  tribute  is  paid  to 
Hygeia,  the  goddess  of  Health  and  Happiness. 


A    PSYCHIATRIC   MILESTONE 


CHARACTERS  AND  SCENES  IN  TABLEAU-PAGEANT 

Music Orchestra 

Overture 

Prologue 

The  Muse  of  History  (Narrator) Adelyn  Wesley 

Spirit  of  the  Past  (Time) Dr.  D.  Austin  Sniffen 

Music Orchestra 

"Amaryllis" 

SCENE  I 

COURT  OF  KING  GEORGE  III. — GRANTING  OF  THE  CHARTER 

Characters: 

King  George  III  Court  Ladies 

Queen  Charlotte  Emissaries 

Prince  of  Wales  Cherokee  Chief 

Court  Chamberlain  Gavot 

Minuet 

Through  dramatic  license,  this  scene  takes  place  in  the  Court 
of  King  George  III.  Colonial  emissaries,  accompanied  by  a 
North  American  Indian,  attend,  and  are  graciously  granted  by 
the  King  a  Royal  Charter  establishing  the  Society  of  the  New 
York  Hospital,  along  with  a  seal,  insignia,  and  a  money  gift. 
A  bit  of  color  and  romance  attaches  to  the  Cherokee's  appearance 
in  the  scene. 

Music Orchestra 

"God  Save  the  King" 
"Minuet  Don  Juan" 

"Largo" 
"Amaryllis" 

SCENE  II 

PINEL   A   LA   SALPTERIERE 

Characters: 

Pinel  Patients  Aides  and  Attendants 

A  courtyard  scene  in  Salpetriere  in  1792.  Hopelessness  and 
chained  despair  are  pictured.  Pinel  enters,  is  saddened  and 

[174] 


TABLEAU- PAGE ANT 

indignant  at  the  sight  of  so  much  unnecessary  suffering,  and 
instantly  orders  the  chains  to  be  struck  off.  The  historic  episode 
closes  in  a  graphic  tableau  depicting  the  gratitude  of  the  released. 

Music . Orchestra 

"Kammenoi  Ostrow" 

SCENE  III 

PORTRAITS PERSONALITIES   OF   THE    PAST 

Thomas  Eddy,  of  the  Board  of  Governors,  1815-1827. 

Dr.  James  Macdonald,  First  Resident  Physician,  1825-1837. 

Dr.  Pliny  Early,  Organizer,  1844-1849. 

Miss  Eliza  Macdonald,  daughter  of  Dr.  Macdonald,  unveils 
the  portrait  of  her  father. 

Music .      .  ....    Orchestra 

"Long,  Long  Ago" 

SCENE  IV 

DOROTHY  LYNDE    DIX   BEFORE   A   LEGISLATIVE   COMMITTEE 

Dorothy  L.  Dix  Members  of  the  Committee  Chairman 

Miss  Dix  appears  before  a  Committee  of  the  Legislature  and  is 
heard  in  an  impassioned  appeal  on  behalf  of  adequate  provision 
and  care  for  the  mentally  ill.  The  scene  closes  with  the  Com- 
mittee indicating  their  approval  and  congratulating  Miss  Dix  on 
her  successful  effort. 

Music Orchestra 

"Maryland,  My  Maryland" 
"Columbia,  the  Gem  of  the  Ocean" 

SCENE  V 

OCCUPATIONAL-RECREATIONAL  ACTIVITIES 

Men's  Crafts  Men's  Sports 

Women's  Crafts  Women's  Sports 

Maypole  Dance 

Supplementing  the  general  medical  work,  the  therapeutic 
value  of  organized  occupational  and  recreational  activities  is 
gaining  increasing  recognition.  Those  arts  and  crafts  lending 
themselves  to  graphic  presentation  are  here  selected:  dyeing, 
weaving,  spinning,  basketry,  caning,  modelling,  painting,  pottery, 
metal  work,  net  making,  gardening,  etc.:  and  similarly,  in  the 

[175] 


A    PSYCHIATRIC   MILESTONE 

recreative    activities,    tennis,    golf,    hockey,    baseball,    croquet, 
bowling,  skiing,  and  skating.     A  Maypole  dance  closes  the  scene. 

Music Orchestra 

"Boccherina" 
"Henry  VIII,  Maypole  Dance" 

SCENE  VI 

INSPIRATIONS 
Characters: 

Hygeia  Britannia 

La  Belle  France  Columbia 

The  closing  scene  is  in  the  nature  of  a  processional  symbolizing 
international  unity  of  purpose  and  a  determination  to  pursue, 
until  finally  attained,  the  goal  of  Health  and  Happiness,  personified 
by  the  goddess  Hygeia. 

Music Orchestra 

"Marseillaise" 

"God  Save  the  King" 

"Battle  Hymn  of  the  Republic" 

"The  Star  Spangled  Banner" 

"Tammany" 


[176] 


NAMES     OF    THOSE    WHO    ATTENDED 
THE    EXERCISES 


NAMES     OF    THOSE    WHO    ATTENDED 
THE    EXERCISES* 

E.  Stanley  Abbot,  M.D.      .      .      .  Philadelphia,  Pa. 

Louise  Acton White  Plains,  N.  Y. 

Elizabeth  I.  Adamson,  M.D.    .      .  White  Plains,  N.  Y. 

William  H.  Alice,  M.D.       .      .      .  Ridgefield,  Conn. 

Thaddeus  H.  Ames,  M.D.  .      .      .  New  York  City. 

Mrs.  George  S.  Amsden       .      .      .  White  Plains,  N.  Y. 

Mrs.  Isadora  Anschutz  ....  White  Plains,  N.  Y. 

Grosvenor  Atterbury      ....  New  York  City. 

Pearce  Bailey,  M.D New  York  City. 

Amos  T.  Baker,  M.D Bedford  Hills,  N.  Y. 

Mrs.  Amos  T.  Baker      ....  Bedford  Hills,  N.  Y. 

Lewellys  F.  Barker,  M.D.  .      .      .  Baltimore,  Md. 

Clifford  W.  Beers New  York  City. 

Christopher  C.  Beling,  M.D.    .      .  Newark,  N.  J. 

Harrison  Betts,  M.D Yonkers,  N.  Y. 

Anna  T.  Bingham,  M.D.     .      .      .  New  York  City. 

Mrs.  Martha  Bird Middletown,  N.  Y. 

Charles  E.  Birch,  M.D.       .      .     '.  White  Plains,  N.  Y. 

J.  Fielding  Black,  M.D.      .      .      .  White  Plains,  N.  Y. 

Mrs.  J.  Fielding  Black  ....  White  Plains,  N.  Y. 

G.  Alder  Blumer,  M.D.       .      .      .  Providence,  R.  I. 

Leonard  Blumgart,  M.D.    .      .      .  New  York  City 

J.  Arthur  Booth,  M.D New  York  City. 

Miss  Helen  Booth New  York  City. 

S.  M.  Boyd Scarsdale,  N.  Y. 

Mrs.  S.  M.  Boyd Scarsdale,  N.  Y. 

Mrs.  Sidney  C.  Borg      ....  New  York  City. 

Rose  Bell  Bradley New  York  City. 

V.  C.  Branham,  M.D New  York  City 

Holly  Brown White  Plains,  N.  Y. 

*  If  any  names  are  omitted  it  is  because  these  names  and  addresses  were  not 
obtained. 

[  179] 


A    PSYCHIATRIC   MILESTONE 

Helen  Brown,  M.D New  York  City. 

Sanger  Brown,  2d,  M.D.     .      .      .  New  York  City. 

Miss  Elizabeth  O.  Buckingham      .  Chicago,  111. 

Alfred  C.  Buckley,  M.D.     .      .      .  Frankford,  Philadelphia,  Pa. 

Alice  Gates  Bugbee,  M.D.  .      .      .  White  Plains,  N.  Y. 

Jesse  C.  M.  Bullowa,  M.D.       .      .  New  York  City. 

William  Browning,  M.D.     .      .      .  Brooklyn,  N.  Y. 

Marie  von  H.  Byers       ....  New  York  City. 

Karl  M.  Bowman,  M.D.     .      .      .  White  Plains,  N.  Y. 

Mrs.  Karl  M.  Bowman        .      .      .  White  Plains,  N.  Y. 

Edna  L.  Byington White  Plains,  N.  Y. 

C.  N.  B.  Camac,  M.D New  York  City. 

C.  Macfie  Campbell,  M.D.       .      .  Boston,  Mass. 

Mrs.  C.  Macfie  Campbell,  M.D.    .  Boston,  Mass. 

Robert  Carroll,  M.D Asheville,  N.  C. 

Mrs.  Robert  Carroll       ....  Asheville,  N.  C. 

Louis  Casamajor,  M.D.       .      .      .  New  York  City. 

Ross  McC.  Chapman,  M.D.     .      .  Towson,  Md. 

Helen  Childs White  Plains,  N.  Y. 

Mrs.  Anne  Choate    .....  Pleasantville,  N.  Y. 

E.  H.  Clarke New  York  City. 

Miss  Marjory  Clark,  R.N.  .      .      .  New  York  City. 

Joseph  Collins,  M.D New  York  City. 

Michael  Collins White  Plains,  N.  Y. 

Arthur  S.  Corwin,  M.D.      .      .      .  Rye,  N.  Y. 

Mrs.  Margaret  Cornwell     .      .      .  New  Rochelle,  N.  Y. 

Henry  A.  Cotton,  M.D.      .      .      .  Trenton,  N.  J. 

Edith  Cox White  Plains,  N.  Y. 

C.  Burns  Craig,  M.D New  York  City. 

Henry  W.  Crane New  York  City. 

Raymond  S.  Crispell,  M.D.      .      .  New  York  City. 

Mrs.  Seymour  Cromwell     .      .      .  Mendham,  N.  Y. 

Hugh  S.  Cummings,M.D.,  Surgeon- 
General  U.  S.  Public  Health  Ser- 
vice    Washington,  D.  C. 

Charles  L.  Dana,  M.D.       .      .      .  New  York  City. 

Thomas  K.  Davis,  M.D.     .      .      .  New  York  City. 

Henderson  Brooke  Deady,  M.D.  .  New  York  City. 

John  W.  Dean White  Plains,  N.  Y. 

[180] 


GUESTS   AT  EXERCISES 

Mrs.  Aline  S.  Devin Eliot,  Maine. 

Allen  Ross  Diefendorf,  M.D.    .      .  New  Haven,  Conn. 

William  Elliott  Dold,  M.D.      .      .  Astoria,  L.  I.,  N.  Y. 

George  Drake White  Plains,  N.  Y. 

John  W.  Draper,  M.D.        .      .      .  New  York  City. 

Nataline  Dullas White  Plains,  N.  Y. 

Charles  S.  Dunlap,  M.D.    .      .      .  New  York  City. 

Mrs.  Alfred  F.  DeNike  .      .      .      .  White  Plains,  N.  Y. 

R.  Condit  Eddy,  M.D New  Rochelle,  N.  Y. 

Joseph  P.  Eidson,  M.D.      .      .      .  White  Plains,  N.  Y. 

Mrs.  Emma  Eldridge     ....  Tuckahoe,  N.  Y. 

Charles  A.  Elsberg,  M.D.    .      .      .  New  York  City. 

William  Else,  M.D New  York  City. 

Everett  S.  Elwood,  Secretary  State 

Hospital  Commission       .      .      .  Albany,  New  York. 

Mrs.  Ezra  H.  Fitch New  York  City. 

Ralph  P.  Folsom,  M.D.       .      .      .  New  York  City. 

Harold  E.  Foster,  M.D.      .      .      .  Boston,  Mass. 

Diana  Fowler White  Plains,  N.  Y. 

Florence  Fuller White  Plains,  N.  Y. 

Isaac  J.  Furman,  M.D.       .      .      .  New  York  City. 

Leslie  Gager,  M.D New  York  City. 

William  C.  Garvin,  M.D.    .      .      .  Kings  Park,  N.  Y. 

Arnold  Gesell,  M.D New  Haven,  Conn. 

Bernard  Glueck,  M.D New  York  City. 

J.  Riddle  Goffe,  M.D New  York  City. 

S.  Philip  Goodhart,  M.D.   .      .      .  New  York  City. 

Miss  Annie  W.  Goodrich,  R.N.      .  New  York  City. 

Phyllis  Greenacre,  M.D.      .      .      .  Baltimore,  Md. 

Menas  S.  Gregory,  M.D.     .      .      .  New  York  City. 

Miss  Pauline  P.  Gunderson       .      .  White  Plains,  N.  Y. 

Louis  J.Haas White  Plains,  N.  Y. 

Thomas  H.  Haines,  M.D.    .      .      .  New  York  City. 

Miss  Dorothy  Hale New  York  City. 

Miss  Natalie  Hall White  Plains,  N.  Y. 

Robert  B.  Hammond,  M.D.     .      .  White  Plains,  N.  Y. 

Miss  Elisa  Hansen White  Plains,  N.  Y. 

[181] 


A    PSYCHIATRIC    MILESTONE 

Milton  A.  Harrington,  M.D.    .      .  Alfred,  N.  Y. 

Isham  G.  Harris,  M.D.        .      .      .  Brooklyn,  N.  Y. 

George  A.  Hastings New  York  City. 

Winifred  Hathaway       .      .      .      .  New  York  City. 

Edna  Haverstock White  Plains,  N.  Y. 

C.  Floyd  Haviland,  M.D.    .      .      .  Middletown,  Conn. 

F.  Ross  Haviland,  M.D.     .      .      .  Brooklyn,  N.  Y. 

Charles  E.  Haynes,  M.D.    .      .      .  New  York  City. 

Eunice  W.  Haydon New  York  City. 

Miss  Katherine  F.  Hearn,  R.N.     .  White  Plains,  N.  Y. 

Edna  Hemingson White  Plains,  N.  Y. 

George  W.  Henry,  M.D.     .      .      .  White  Plains,  N.  Y. 

Mrs.  George  W.  Henry        .      .      .  White  Plains,  N.  Y. 

Marcus  B.  Heyman,  M.D.        .      .  New  York  City. 

Beatrice  M.  Hinkle,  M.D.  .      .      .  New  York  City. 

L.  E.  Hinsie,  M.D New  York  City. 

P.  F.  Hoffman,  M.D White  Plains,  N.  Y. 

John  F.  Holden,  M.D White  Plains,  N.  Y. 

Hubert  S.  Howe,  M.D.        .      .      .  New  York  City. 

Thomas  Howell,  M.D New  York  City. 

J.  Ramsay  Hunt,  M.D.       .      .      .  New  York  City. 

Helen  Hunt    .......  White  Plains,  N.  Y. 

Miss  Augusta  M.  Huppuch       .      .  New  York  City. 

Richard  H.  Hutchings,  M.D.    .      .  Utica,  N.  Y. 

Frank  N.  Irwin,  M.D New  York  City. 

Martha  Joffe White  Plains,  N.  Y. 

Walter  B.  James,  M.D.       .      .      .  New  York  City. 

Mrs.  Walter  James White  Plains,  N.  Y. 

Professor  Pierre  Janet,  M.D.    .      .  Paris,  France. 

Madame  Pierre  Janet     ....  Paris,  France. 

M.  E.  Jarvis,  M.D New  York  City. 

Rev.  Oscar  Jarvis White  Plains,  N.  Y. 

Walter  Jennings Cold  Spring  Harbor,  L.  L,  N.  Y. 

Miss  Gudron  Johannessen,  R.N.    .  White  Plains,  N.  Y. 

Miss  Marguerite  Jewell       .      .      .  White  Plains,  N.  Y. 

Miss  Florence  M.  Johnson  .      .      .  New  York  City. 

Kenneth  B.  Jones,  M.D.     .      .      .  Thiells,  N.  Y. 

Miss  Minnie  Jordan,  R.N.        .      .  New  York  City. 

[182] 


GUESTS   AT  EXERCISES 

Mrs.  De  Lancey  A.  Kane    .      .      .  New  Rochelle,  N.  Y. 

Lilian  A.  Kelm New  York  City. 

James  P.  Kelleher,  M.D.     .      .      .  New  York  City. 

Foster  Kennedy,  M.D New  York  City. 

Marion  E.  Ken  worthy,  M.D.   .      .  New  York  City. 

John  Joseph  Kindred,  M.D.     .      .  Astoria,  L.  I.,  N.  Y. 

George  W.  King,  M.D.        .      .      .  Secaucus,  N.  J. 

Hermann  G.  Klotz,  M.  D.  .      .      .  White  Plains,  N.  Y. 

George  W.  Kline,  M.D.       .      .      .  Boston,  Mass. 

George  H.  Kirby,  M.D.       .      .      .  New  York  City. 

Henry  Klopp,  M.D Allentown,  Pa. 

Augustus  S.  Knight,  M.D.        .      .  New  York  City. 

Frank  Henry  Knight,  M.D.      .      .  White  Plains,  N.  Y. 

Mary  S.  Kirkbride Albany,  N.  Y. 

Walter  M.  Kraus,  M.D.      .      .      .  New  York  City. 

Edward  J.  Kempf,  M.D.     .      .      .  New  York  City. 

Alexander  Lambert,  M.D.  .      .      .  New  York  City. 

Charles  I.  Lambert,  M.D.  .      .      .  White  Plains,  N.  Y. 

Mrs.  Charles  I.  Lambert     .      .      .  White  Plains,  N.  Y. 

Arthur  G.  Lane,  M.D Greystone  Park,  N.  J. 

G.  Alfred  Lawrence,  M.D.  .      .      .  New  York  City. 

W.  A.  Lawrence,  M.D White  Plains,  N.  Y. 

Ruth  W.  Lawton White  Plains,  N.  Y. 

Helen  Letson White  Plains,  N.  Y. 

Samuel  Leopold,  M.D.        .      .      .  Philadelphia,  Pa. 

Maurice  J.  Lewi,  M.D.        ...  New  York  City. 

Mrs.  Maurice  J.  Lewi    ....  New  York  City. 

Miss  Ella  H.  Lowe White  Plains,  N.  Y. 

Walter  E.  Lowthian,  M.D.       .      .  White  Plains,  N.  Y. 

F.  R.  Lyman,  M.D Hastings-on-Hudson,  N.  Y. 

Samuel  B.  Lyon,  M.D New  York  City. 

Winslow  Lyon New  York  City. 

William  H.  McCastline,  M.D.        .  New  York  City. 

John  T.  McCurdy,  M.D.     .      .      .  New  York  City. 

Carlos  F.  MacDonald,  M.D.    .      .  New  York  City. 

D.  W.  McFarland,  M.D.     .      .      .  Greens  Farms,  Conn. 

Miss  Eliza  Macdonald   ....  Flushing,  L.  I.,  N.  Y. 

John  W.  Mackintosh     ....  White  Plains,  N.  Y. 

[183] 


A    PSYCHIATRIC    MILESTONE 

Daniel  W.  Maloney        ....  White  Plains,  N.  Y. 

Grace  F.  Marcus,  M.D.       .      .      .  White  Plains,  N.  Y. 

L.  Markham,  M.D Amityville,  N.  Y. 

Miss  Anna  Maxwell,  R.N.  .      .      .  New  York  City. 

John  F.  W.  Meagher,  M.D.      .      .  Brooklyn,  N.  Y. 

Adolf  Meyer,  M.D Baltimore,  Md. 

Carlos  J.  Miller,  M.D White  Plains,  N.  Y. 

Henry  W.  Miller,  M.D.       .      .      .  Brewster,  N.  Y. 

Mrs.  R.  Van  C.  Miller        .      .      .  New  York  City. 

George  W.  Mills,  M.D.        .      .      .  Central  Islip,  N.  Y. 

Henry  Moffett,  M.D Yonkers,  N.  Y. 

Mrs.  Maude  G.  Moody       .      .      .  New  York  City. 

Miss  Madeline  Moore    ....  White  Plains,  N.  Y. 

Joseph  W.  Moore,  M.D.      .      .      .  Beacon,  N.  Y. 

Eugene  T.  Morrison,  M.D.       .      .  New  Rochelle,  N.  Y. 

Miss  Cecil  Morrison       ....  White  Plains,  N.  Y. 

Richard  W.  Moriarty,  M.D.     .      .  White  Plains,  N.  Y. 

Herman  Mortensen,  R.N.   .      .      .  White  Plains,  N.  Y. 

Walter  W.  Mott,  M.D.        .      .      .  White  Plains,  N.  Y. 

Florence  Munn White  Plains,  N.  Y. 


Theodore  W.  Neumann,  M.D.       .  Central  Valley,  N.  Y. 

Ethan  A.  Nevin,  M.D Newark,  N.  J. 

Miss  Christine  M.  Nuno     .      .      .  New  York  City. 

George  O'Hanlon,  M.D.      .      .      .  New  York  City. 

James  M.  O'Neill  ....  Harrison,  N.  Y. 

Herman  Ostrander,  M.D.    .      .      .  Kalamazoo,  Mich. 

Mary  F.  O'Grady White  Plains,  N.  Y. 

Flavius  Packer,  M.D Riverdale,  N.  Y. 

Mrs.  Flavius  Packer       ....  Riverdale,  N.  Y. 

Irving  H.  Pardee,  M.D.       .      .      .  New  York  City. 

Jason  S.  Parker,  M.D White  Plains,  N.  Y. 

Frederick  W.  Parsons,  M.D.     .      .  Buffalo,  N.  Y. 

Miss  Margaret  Patin      ....  White  Plains,  N.  Y. 

Stewart  Paton,  M.D Princeton,  N.  J. 

Christopher  J.  Patterson,  M.D.     .  Troy,  N.  Y. 

[184] 


GUESTS    AT    EXERCISES 


Guy  Payne,  M.D 

Arthur  M.  Phillips,  M.D.    .      .      . 

Charles  W.  Pilgrim,  M.D.,  Chair- 
man, State  Hospital  Commission, 
N.  Y 

Mason  Pitman,  M.D 

Miss  Leah  Pitman 

Miss  Adele  S.  Poston,  R.N.      .      . 

Howard  W.  Potter,  M.D.    .      .      . 

Wilson  M.  Powell 

Mrs.  Margaret  J.  Powers     . 

Miss  Nina  Prey 

W.  B.  Pritchard,  M.D 

Morton  Prince,  M.D 

Rose  Pringle,  M.D 

Sylvanus  Purdy,  M.D 

Paul  R.  Radosvljevich,  M.D.  .      . 
E.  Benjamin  Ramsdell,  M.D.  . 
Edwin  G.  Ramsdell,  M.D.  .      .      . 
Mortimer  W.  Raynor,  M.D.     . 
Lawrence  F.  Rainsford,  M.D.  . 
Mrs.  Lawrence  F.  Rainsford     . 

Henry  A.  Riley,  M.D 

Miss  Elise  Reilly 

Frank  W.  Robertson,  M.D.      .      . 

M.  A.  Robinson,  M.D 

William  C.  Roden,  R.N.      .      .      . 

A.  J.  Rosanoff,  M.D 

Miss  Catherine  Ross,  R.N. 

John  T.  W.  Rowe,  M.D.     .      .      . 

Richard  G.  Rows,  M.D.      .      .      . 

Frederick  D.  Ruland,  M.D.      .      . 

William  L.  Russell,  M.D.    .      .      . 

Mrs.  William  L.  Russell 

Earnest  F.  Russell,  M.D.    .      .      . 

Paul  L.  Russell 

Mrs.  Paul  L.  Russell      .... 

Walter  G.  Ryon,  M.D 

Miss  Helen  K.  Ryce       .... 


Cedar  Grove,  N.  J. 
New  York  City. 


Central  Valley,  N.  Y. 
Riverdale-on-Hudson,  N.  Y. 
White  Plains,  N.  Y. 
White  Plains,  N.  Y. 
Thiells,  N.  Y. 
New  York  City. 
New  York  City. 
New  York  City. 
New  York  City. 
Boston,  Mass. 
White  Plains,  N.  Y. 
White  Plains,  N.  Y. 

New  York  City. 
New  York  City. 
White  Plains,  N.  Y. 
New  York  City. 
Rye,  N.  Y. 
Rye,  N.  Y. 
New  York  City. 
White  Plains,  N.  Y. 
New  York  City. 
New  York  City. 
White  Plains,  N.  Y. 
Kings  Park,  N.  Y. 
White  Plains,  N.  Y. 
New  York  City. 
London,  England. 
Westport,  Conn. 
White  Plains,  N.  Y. 
White  Plains,  N.  Y. 
New  York  City. 
White  Plains,  N.  Y. 
White  Plains,  N.  Y. 
Poughkeepsie,  N.  Y. 
Poughkeepsie,  N.  Y. 


[185] 


A    PSYCHIATRIC    MILESTONE 

Miss  Helen  Sayre White  Plains,  N.  Y. 

Thomas  W.  Salmon,  M.D.        .      .  New  York  City. 

Mrs.  Thomas  W.  Salmon    .      .      .  New  York  City. 

Irving  J.  Sands,  M.D Brooklyn,  N.  Y. 

James  P.  Sands,  M.D Philadelphia,  Pa. 

William  C.  Sandy,  M.D.     .      .      .  New  York  City. 

Miss  E.  Saul New  York  City. 

William  G.  Schauffler,  M.D.     .      .  Princeton,  N.  J. 

Paul  Schlegman,  M.D White  Plains,  N.  Y. 

H.  Ernest  Schmid,  M.D.     .      .      .  White  Plains,  N.  Y. 

Miss  Gertrude  Schmid         .      .      .  White  Plains,  N.  Y. 

Augusta  Scott,  M.D New  York  City. 

Major  Louis  L.  Seaman,  M.D.       .  New  York  City. 

Edward  W.  Sheldon       ....  New  York  City. 

George  Sherrill,  M.D Stamford,  Conn. 

Miss  Eloise  Shields,  R.N.    .      .      .  White  Plains,  N.  Y. 

Lewis  M.  Silver,  M.D New  York  City. 

Mrs.  A.  Slesingle New  York  City. 

Mrs.  Anna  C.  Schermerhorn     .      .  New  York  City. 

Rev.  Frank  H.  Simmonds  .      .      .  White  Plains,  N.  Y. 

Clarence  J.  Slocum,  M.D.  .      .      .  Beacon,  N.  Y. 

Mrs.  Clarence  J.  Slocum     .      .      .  Beacon,  N.  Y. 

Augustine  J.  Smith New  York  City. 

Miss  M.  Smith,  R.N Titusville,  Pa. 

Philip  Smith,  M.D New  York  City. 

Rev.  George  H.  Smyth  ....  Scarsdale,  N.  Y. 

D.  Austin  Sniffen,  D.D.       .      .      .  White  Plains,  N.  Y. 

John  D.  Southworth,  M.D.      .      .  New  York  City. 

Edith  E.  Spaulding,  M.D.  .      .     .  New  York  City. 

M.  Allen  Starr,  M.D New  York  City. 

Samuel  A.  Steele White  Plains,  N.  Y. 

William  Steinach,  M.D.       .      .      .  New  York  City. 

George  S.  Stevenson,  M.D.       .      .  New  York  City. 

Adolf  Stern,  M.D New  York  City. 

Emil  Strateman White  Plains,  N.  Y. 

Israel  Strauss,  M.D New  York  City. 

Frank  K.  Sturgis New  York  City. 

Miss  Mary  Ruth  Swann,  R.N.       .  Washington,  D.  C. 

C.  C.  Sweet,  M.D Ossining,  N.  Y. 

Sarah  Swift White  Plains,  N.  Y. 

[186] 


GUESTS    AT  EXERCISES 

William  B.  Terhune,  M.D.       .      .  New  Haven,  Conn. 

William  J.  Tiffany,  M.D.    .      .      .  New  York  City. 

Walter  Clark  Tilden,  M.D.       .      .  Hartsdale,  N.  Y. 

Frederick  Tilney,  M.D.       .      .      .  New  York  City. 

Walter  Timme,  M.D New  York  City. 

Howard  Townsend New  York  City. 

E.  Clark  Tracy,  M.D White  Plains,  N.  Y. 

Walter  L.  Treadway,  M.D.       .      .  Washington,  D.  C. 

Miss  Gertrude  Trefrey,  R.N.    .      .  White  Plains,  N.  Y. 

Miss  Mary  G.  Urquhart      .      .      .  White  Plains,  N.  Y. 

J.  L.  Van  deMark,  M.D.     .      .      .  Albany,  N.  Y. 

T.  J.  Vosburgh,  M.D White  Plains,  N.  Y. 

Henry  J.  Vier,  M.D White  Plains,  N.  Y. 

Emory  M.  Wadsworth,  M.D.  .      .  Brooklyn,  N.  Y. 

Miss  Lillian  D.  Wald,  R.N.      .      .  New  York  City. 

Professor  Howard  C.  Warren   .      .  Princeton,  N.  J. 

Mrs.  Caroline  E.  Washburn      .      .  White  Plains,  N.  Y. 

Miss  Martha  Washburn      .      .      .  White  Plains,  N.  Y. 

G.  F.  Washburne,  M.D.      .      .      .  Hastings-on-Hudson,  N.  Y. 

Chester  Waterman,  M.D.    .      .      .  New  York  City. 

James  J.  Waygood,  M.D.    .      .      .  White  Plains,  N.  Y. 

Mrs.  James  J.  Waygood      .      .      .  White  Plains,  N.  Y. 

R.  G.  Wearne,  M.D New  York  City. 

Edward  W.  Weber,  M.D.    .      .      .  White  Plains,  N.  Y. 

Israel  S.  Wechsler,  M.D.     .      .      .  New  York  City. 

Miss  Kathryn  I.  Wellman  .      .      .  White  Plains,  N.  Y. 

Mrs.  Adelyn  Wesley       ....  New  York  City. 

Lt.  Col.  Arthur  W.  Whaley,  M.D.  New  York  City. 

Mrs.  Arthur  W.  Whaley      .      .      .  New  York  City. 

Miss  Margaret  Wheeler       .      .      .  Short  Hills,  N.  J. 

Payne  Whitney New  York  City. 

Frankwood  E.  Williams,  M.D.       .  New  York  City. 

Rodney  R.  Williams,  M.D.       .      .  Poughkeepsie,  N.  Y. 

O.  J.  Wilsey,  M.D Amityville,  N.  Y. 

John  E.  Wilson,  M.D.    ....  New  York  City. 

Miss  A.  Wilson New  York  City. 

J.  M.  Winfield,  M.D Brooklyn,  N.  Y. 

[187] 


A    PSYCHIATRIC   MILESTONE 


G.  Howard  Wise 
Miss  Frances  E.  Wood  . 
Robert  C.  Woodman,  M.D. 
Robert  S.  Woodworth,  Ph.D. 

Rev.  John  C.  York  .      .      . 

Edwin  G.  Zabriskie,  M.D.  . 
Charles  C.  Zacharie,  M.D. 


New  York  City. 
White  Plains,  N.  Y. 
Middletown,  N.  Y. 
New  York  City. 

Brooklyn,  N.  Y. 

New  York  City. 
White  Plains,  N.  Y. 


[188] 


APPENDICES 


APPENDIX    I 

COMMUNICATIONS   FROM   DR.    BEDFORD  PIERCE, 

MEDICAL   SUPERINTENDENT  OF  THE 

RETREAT,   YORK,   ENGLAND 

May  5th,  1921. 
DEAR  DR.  RUSSELL: 

I  have  read  with  much  pleasure  your  pamphlet  giving  the 
history  of  Bloomingdale  Hospital.  The  reproduction  in  fac- 
simile of  Thomas  Eddy's  communication*  is  especially  interest- 
ing and  it  will  be  placed  with  the  records  of  the  early  days  of  the 
Retreat. 

We  have  looked  through  the  Minutes,  which  are  complete 
from  the  opening  of  the  Retreat  in  1796,  and  also  examined  a 
large  number  of  original  letters  of  William  and  Samuel  Tuke 
respecting  the  Institution,  but  have  not  succeeded  in  tracing 
the  letter  from  S.  Tuke  to  William  Eddy,  to  which  you  refer. 
As  you  are  probably  aware,  S.  Tuke  was  the  grandson  of  William 
Tuke,  the  founder,  and  when  he  published  the  History  of  the 
Retreat  in  1812  he  was  but  twenty-eight  years  of  age.  This 
book  had  a  far-reaching  influence  on  the  treatment  of  the  in- 
sane, and  it  is  remarkable  that  a  man  untrained  in  medicine 
and  without  university  education  should  have  been  able  to 
write  it.  The  book  is  now  very  rare,  but  as  we  have  three 
duplicate  copies,  I  am  authorized  by  the  Directors  of  the  Re- 
treat to  present  your  Hospital  with  one  of  them.  I  have  al- 
ready sent  you  a  copy  of  an  address  of  my  own  dealing  with 
Psychiatry  in  England  at  about  the  time  your  Hospital  was 
instituted. 

*  Bloomingdale  Hospital  Press. 

[191] 


APPENDIX    I 

The  use  of  the  term  "moral  treatment"  as  opposed  to  treat- 
ment of  physical  disease  has  in  recent  years  become  especially 
interesting.  It  is  clear  that  Tuke  and  Pinel  foresaw  that  psy- 
chotherapeutic  treatment  is  necessary,  and  their  efforts  were 
directed  towards  providing  effective  "sublimation"  of  mis- 
directed psychical  energy. 

One  is  pleased  to  see  in  your  report  the  extent  to  which  organ- 
ized occupations  are  developed  at  Bloomingdale — a  pleasure 
not  unmixed  with  envy  at  seeing  the  picture  of  the  men's  occu- 
pational pavilion,  and  the  prospective  erection  of  a  similar 
building  for  women. 

In  the  early  days  of  the  Retreat  large  numbers  of  visitors 
came  from  all  parts  of  the  world.  There  is  a  gap  in  the  Visitors' 
Book  between  1800-1815,  and  the  list  of  visitors  is  not  complete. 

We  have  copied  out  the  names  of  the  American  Visitors,  to- 
gether with  an  entry  by  John  W.  Francis,  M.D.,  in  1815.  It  is 
interesting  to  note  that  an  American  woman  Friend,  Hannah 
Field,  was  accompanied  to  the  Retreat  by  Elizabeth  Fry.  In 
1818  a  party  of  North  American  Indians  visited  the  Retreat 
and  signed  the  Visitors'  Book  with  pictorial  representations  of 
their  names.  These  we  have  had  photographed  and  I  send  the 
prints  herewith. 

May  I  congratulate  you  on  the  centenary  of  your  Hospital 
and  also  congratulate  you  and  the  Governors  on  its  remarkable 
development  and  progress.  Here  at  the  Retreat  we  carry  on 
using  the  original  buildings  still,  striving  to  give  our  patients 
modern  treatment  in  premises  now  almost  ancient,  but  which  do 
not  appear  so  out  of  date  in  this  City  of  York.  York  congratu- 
lates New  York  upon  its  wonderful  prosperity,  and  we  gladly 
recognize  its  development  in  the  practice  of  psychiatry  fully 
corresponds  with  its  development  in  other  directions. 
I  remain, 

Yours  sincerely, 

BEDFORD  PIERCE. 


[  192] 


GREETINGS    FROM   YORK    RETREAT 

EXTRACT  FROM  MINUTES   OF   BOARD  OF  DIRECTORS  OF  THE 

RETREAT 

The  Retreat,  York 

Meeting  of  Directors  held  on  April  the  3Oth,  1921 
Copy  of  Minute  No.  8 

At  this  Meeting  of  the  Directors  and  Agents  of  York  Retreat 
we  hear  with  pleasure  that  the  Bloomingdale  Hospital,  the  sec- 
tion of  the  Society  of  the  New  York  Hospital  devoted  to  the 
Treatment  of  Mental  Diseases,  is  to  celebrate  next  month  the 
centenary  of  its  foundation.  The  facsimile  reproduction  of 
the  letter  of  Thomas  Eddy  which  has  been  presented  to  the 
Retreat  Library  is  specially  interesting  to  us  as  it  acknowledges 
the  pioneer  work  at  the  Retreat  and  specially  refers  to  cor- 
respondence with  Samuel  Tuke.  We  have  pleasure  in  sending 
to  the  Governors  of  the  Bloomingdale  Hospital  a  copy  of  Samuel 
Tuke's  classical  work  "The  Description  of  the  Retreat"  in  the 
belief  that  the  principles  therein  set  forth  are  of  lasting  impor- 
tance. We  send  our  hearty  congratulations  to  the  Blooming- 
dale  Hospital  on  its  century  of  good  work  and  wish  it  every 
success  in  the  future. 

Signed, 

CHARLES  WEOMANS,  Chairman. 

OSCAR  F.  RUMLEN,  Treasurer. 


TRANSCRIPT  FROM  THE  VISITORS  BOOK  OF  THE  RETREAT 
EARLY  AMERICAN  VISITORS 

1803.     3  mon  nth.     Abrm.  Barker,  New  Bedford,  Massachu- 

sits,  a  young  man  (a  Friend)  on  a  tour;  has  been  in 

Russia,  Denmark,  Sweden  &  Holland. 

(In  William  Tuke's  writing) 
1815.     Nov.  30.     John  W.  Francis,  M.D.  of  N.  York.     J.  W. 

Francis  is  not  wholly  ignorant  of  the  State  of  the 

[  193  ] 


APPENDIX    I 

Lunatic  Asylums  in  North  America,  and  he  has  visited 
almost  all  the  institutions  for  the  Insane  that  are 
established  in  England.  He  now  embraces  this  op- 
portunity of  stating  that  after  an  examination  of  the 
Retreat  for  some  hours,  he  should  do  injustice  to  his 
feelings  were  he  not  to  declare  that  this  establishment 
far  surpasses  anything  of  the  kind  he  has  elsewhere 
seen,  and  that  it  reflects  equal  credit  on  the  wisdom 
and  humanity  of  its  conductors. 

Perhaps  it  is  no  inconsiderable  honour  to  add  that 
institutions  of  a  similar  nature  and  on  the  same  plan 
are  organizing  in  different  parts  of  the  United  States. 
The  New  World  cannot  do  better  than  imitate  the 
old  so  far  as  concerns  the  management  of  those  who 
labour  under  mental  infirmities.  J.  W.  F. 

1816.     i  Mon  4.     Sharon  Carter,  Philadelphia. 

1816.     I  mon.     Wm.  S.  Warder,  from  Philadelphia. 

1816.  2  mon  21.  Rev.  Thomas  H.  Gallaudet,  who  visits 
Europe  for  the  purpose  of  qualifying  himself  to  superin- 
tend an  Asylum  for  the  Deaf  and  Dumb,  proposed  to 
be  established  in  Hartford,  Connecticut,  of  the  United 
States  of  America. 

1816.     4  mon  8th.     Archibald  Grade,  Junr.,  New  York. 

1816.     April  29th.     George  F.  Randolph,  Philadelphia. 
John  Hastings,  Baltimore. 

1816.     6  mon  igth.     Charles  Longstreth,  from  Philadelphia. 

1816.  6  mon  igth.     Jacob  Smedley,  from  Philadelphia. 

1817.  7  mon.     Henry  Kollock,  of  Savannah,  Georgia. 

Dr.  Wm.  Parker,  Savannah. 

G.  C.  Fersslanchi,  of  New  York. 
1817.     11/24.     Hannah  Field,  North  America,  with  Elizabeth 

Fry. 
1817.     12   Mo.     G.   /.    Browne,    United    States    of   America 

(Cincinnati). 


194] 


In  1815  Thomas  Eddy,  one  of  the  Governors  of  the  Society  of  the  New  York  Hospital,  presented 
a  communication  in  which  he  advocated  the  establishment  in  the  country  of  a  branch  for 
the  moral  treatment  of  the  insane.  This  led  to  the  establishment  of  Bloomingdale  Asylum. 


APPENDIX  II 

A  LETTER  ON  PAUPER  LUNATIC  ASYLUMS* 

The  Governors  of  the  New  York  Hospital,  conceiving  that 
the  very  judicious  remarks  and  sentiments  contained  in  the 
following  letter,  might  be  highly  useful  to  the  community,  as 
well  as  to  the  institution  with  which  they  are  connected,  have 
requested  the  same  to  be  published.  The  work  alluded  to  in 
the  letter,  called,  "Practical  hints  on  the  construction  and 
economy  of  Pauper  Asylums,"  is  believed  to  be  one  of  the  most 
valuable  and  interesting  works  of  the  kind  ever  published. 
This  work  was  sent  by  the  author  to  one  of  the  Governors,  and 
is  now  deposited  in  the  Hospital  library.  It  is  very  desirable 
that  it  should  be  republished  in  this  country;  but  as  such  re- 
publication  would  be  expensive,  on  account  of  the  few  copies 
that  would  be  wanted,  the  Governors  have  directed,  that  if 
any  person,  or  trustees  of  any  public  institution,  in  any  part  of 
the  United  States,  should  be  desirous  of  obtaining  a  copy  of 
this  very  valuable  work,  with  a  view  to  aid  them  in  erecting  a 
similar  Asylum,  or  the  improvement  of  any  already  established, 
that  a  manuscript  copy  shall  be  furnished  them,  upon  an  appli- 
cation to  the  subscriber, 

THOMAS  EDDY. 

New-York,  I2th  month,  soth,  1815. 

YORK,  ymo.  lyth,  1815. 
To  Thomas  Eddy, 

OUR  mutual  friend,  L.  Murray,  has  put  into  my  hands  a 
letter  and  pamphlet,  lately  received  from  thee,  respecting  the 
erection  of  an  asylum  for  lunatics  near  New-York.f  He  has 
wished  me  to  make  any  remarks  which  may  occur  to  me  on  the 

*  A  letter  on  Pauper  Lunatic  Asylums,  by  Samuel  Tuke,  New  York,  1815. 
Reprinted  Bloomingdale  Hospital  Press,  June  3,  1919. 
f  Appendix  III. 

[195] 


APPENDIX    II 

perusal;  but,  having  just  published  a  few  hints  on  the  construc- 
tion and  economy  of  Pauper  Lunatic  Asylums,  which  contain 
much  of  the  information  thou  requests,  I  shall  have  but  little  to 
add.  Those  hints,  however,  relating  to  institutions  for  the  poor- 
est class  of  society,  must  be  applied  with  some  modifications  to 
establishments  for  persons  of  different  pervious  habits,  and  for 
whom  a  greater  portion  of  attendance  can  be  afforded.  The 
great  objects,  however,  which  are  stated  in  the  hints  to  be  so 
important  for  the  comfort  of  lunatics,  apply  equally  to  those  of 
all  ranks  and  classes. 

From  the  sum  you  propose  to  receive  from  the  patients,  in- 
tended to  occupy  the  new  building,  I  conclude  you  are  provid- 
ing for  patients  of  the  middle  ranks  of  life,  a  class  hardly  less 
to  be  commiserated,  when  thus  afflicted,  than  the  very  poorest, 
since  the  expense  and  difficulty  of  private  management,  may 
bring  to  ruin  a  respectable  family,  as  well  as  expose  it  to  great 
personal  dangers.  There  would,  I  think,  be  considerable  ob- 
jection to  the  accumulation  of  40  patients  of  this  class,  in  three 
contiguous  rooms,  as  proposed  in  the  hints  for  pauper  lunatics. 
You  purpose  building  for  50  patients,  and  as  you  probably  in- 
tend to  accommodate  both  sexes,  the  number  of  each  sex  may  be 
very  suitable  for  the  accommodation  of  three  contiguous  rooms, 
which,  of  course,  need  not  be  so  large  as  those  in  the  Wakefield 
Asylum.  It  would  be  difficult  to  offer  a  detailed  plan,  without 
knowing  more  than  we  do  of  your  local  circumstances,  and  the 
classes  of  patients  you  purpose  to  admit.  I  doubt,  however, 
whether  you  can  do  better  than  to  adopt  the  general  form  of 
the  Wakefield  Asylum,  and  as  you  are  providing  for  only  a  small 
number,  it  deserves  consideration  whether  all  the  rooms  might 
not  be  advantageously  placed  on  the  ground  floor.  This  plan 
affords  great  facilities  to  easy  inspection,  and  safe  communica- 
tion with  airing  grounds,  and  the  roof  might  project  so  far  over 
the  building,  as  to  form  an  excellent  collonnade  for  the  patients; 
which  seems  peculiarly  desirable  under  an  American  Sun. 

With  these  views,  I  send  a  sketch  drawn  by  the  Architect 
whose  plan  is  to  be  adopted  at  Wakefield;  and  though  it  may 
not  be,  in  many  respects,  adapted  to  your  particular  wants,  yet 

[196] 


SAMUEL  TUKE  TO  THOMAS  EDDY 

I  hope  it  will  not  be  altogether  useless.  Should  it  be  thought 
too  expensive,  I  think  the  rooms,  I,  2,  and  3,  might  be  dispensed 
with,  and  rooms  marked  "attendants,  sick  and  bath,"  might 
be  appropriated  to  the  patients  during  the  day.  The  atten- 
dants room  is  not  a  requisite,  though  it  has  been  thought  that 
it  would  be  more  agreeable  to  patients  of  superior  rank,  not  to 
have  the  society  of  a  servant.  This,  however,  chiefly  applies 
to  the  convalescents,  and  these  might  occupy  the  room  marked 
'sick',  whilst  the  middle  class,  and  the  attendants,  would  be  in 
the  centre,  marked  "attendants."  A  sick  and  bath  room  might 
probably  be  obtained  in  the  galleries:  if  you  are  inclined  for 
the  sake  of  appearance,  to  make  the  centre  building  two  stories 
high,  you  might  bring  the  wings  nearer  to  the  centre,  and  ac- 
commodate most  of  the  convalescent  patients  with  bed  rooms 
in  the  upper  story.  In  this  case,  perhaps  it  would  be  desirable 
to  give  the  wings  a  radiating  form.  You  will  however  be  best 
able  to  modify  the  sketch  to  your  particular  wants,  if  the  gen- 
eral idea  should  meet  your  approbation. 

I  observe  with  pleasure,  that  one  leading  feature  of  your  new 
institution,  is  the  introduction  of  employment  amongst  the 
patients,  an  object  which  I  am  persuaded  is  of  the  utmost  im- 
portance in  the  moral  treatment  of  insanity.  It  is  related  of  an 
institution  in  Spain,  which  accommodated  all  ranks,  and  in 
which  the  lower  class  were  generally  employed,  that  a  great 
proportion  of  these  recovered,  whilst  the  number  of  the  Grandees 
was  exceedingly  small.  It  will  however,  require  great  address 
to  induce  patients  to  engage  in  manual  labour,  who  have  not 
been  accustomed  to  it  previously  to  their  indisposition,  and  it 
must  be  admitted,  that  where  the  reluctance  on  the  part  of  the 
patient  is  great,  the  irritation  which  compulsory  means  are 
likely  to  excite,  will  probably  be  more  injurious  to  the  patient, 
than  the  exercise  will  be  beneficial.  The  employment  of  insane 
persons  should,  as  far  as  it  is  practicable,  be  adapted  to  their 
previous  habits,  inclinations  and  capacities,  and,  though  horti- 
cultural pursuits  may  be  most  desirable,  the  greatest  benefit 
will,  I  believe,  be  found  to  result  from  the  patient  being  engaged 
in  that  employment  in  which  he  can  most  easily  excel,  whether 

[  197] 


APPENDIX    II 

it  be  an  active  or  a  sedentary  one.  If  it  be  the  latter,  of  course 
sufficient  time  should  be  allotted  to  recreation  in  the  air.  Some 
persons  imagine,  that  exercises  of  diversion,  are  equally  beneficial 
with  those  that  are  useful.  The  latter  appear  to  me  to  possess 
a  decided  preference,  by  imparting  to  the  mind  that  calm  feel- 
ing of  satisfaction,  which  the  mere  arts  of  amusement,  though 
not  to  be  neglected,  can  never  afford.  To  the  melancholy 
class,  this  is  an  important  distinction  between  amusing  and  use- 
ful employments,  and  labour  is  to  be  prefered  for  the  maniacal 
class  as  less  calculated  to  stimulate  the  already  too  much  excited 
spirits. 

It  is  proposed  that  the  new  asylum  should  be  placed  a  few 
miles  from  the  city.  The  visitors  to  it,  (I  do  not  mean  the 
medical  ones)  will,  I  presume,  be  residents  in  New- York,  and 
from  what  I  have  seen  of  the  zeal  of  persons  under  such  appoint- 
ments in  this  country,  it  appears  desirable,  to  render  the  per- 
formance of  this  duty,  so  important  for  the  welfare  of  asylums, 
as  easy  as  it  can  be  with  propriety.  One  mile  perhaps  would 
not  be  objectionable,  and  might  probably  afford  as  good  air 
and  retirement,  as  a  greater  distance. 

I  need  hardly  say,  I  was  much  gratified  to  find  by  the  pamph- 
let, that  the  importance  of  moral  treatment  in  the  cure  of  in- 
sanity, was  duly  appreciated  in  America.  When  we  consider, 
as  Lord  Bacon  observes,  speaking  of  common  diseases,  that 
"all  wise  physicians  in  the  prescription,  of  their  regimen  to 
their  patients,  do  ever  consider  accidentia  animi,  as  of  great 
force  to  further  or  hinder  remedies  or  recoveries;"  it  is  difficult 
to  account  for  the  general  neglect  of  moral  considerations  in  the 
treatment  of  deranged  mind.  I  hope,  however,  though  in  many 
instances  medicine  may  not  be  employed  with  advantage,  and 
its  indiscriminate  use  has  been  seriously  injurious,  that  we 
shall  not  abandon  it  as  altogether  useless,  in  what  we  term  dis- 
ease of  the  mind.  All  the  varieties,  included  under  this  general 
term,  have  been  produced  by  physical  causes:  by  external  acci- 
dents, by  intoxication,  the  improper  use  of  medicines,  repelled 
eruptions,  obstructed  secretions,  &c.  In  some  instances,  dis- 
section has  discovered,  after  death,  the  cause  of  the  mental 

[I98] 


SAMUEL  TUKE  TO  THOMAS  EDDY 

affection,  and  though,  in  many  instances,  no  physical  cause 
can  be  detected,  yet,  when  it  is  considered,  how  limited  are  the 
investigations  of  the  anatomist,  and  that  the  art  is  so  imperfect, 
that  diseases  occasioning  instant  death,  cannot  always  be  dis- 
covered on  the  most  minute  dissection,  it  is  not  unreasonable 
to  suppose,  that  the  body  is  in  all  cases  the  true  seat  of  the 
disease. 

All  I  would  infer  from  this  speculation  is,  the  importance  of 
having  judicious  medical  attendants,  to  watch  the  progress  of 
the  disorder,  to  be  ready  to  apply  their  art  as  bodily  symptoms 
may  arise,  and  to  ascertain,  with  greater  precision  than  has 
hitherto  been  done,  "  how  and  how  far  the  humours  and  effects 
of  the  body,  do  alter  and  work  upon  the  mind;  and  how  far  the 
passions  and  apprehensions  of  the  mind,  do  alter  and  work  upon 
the  body."  Even  if  the  disease  is  not  confined  to  the  corporal 
organs  of  mind,  but  extends  to  the  pure  and  eternal  intelligence, 
medical  aid  may  still  be  useful  from  the  well  known  reciprocal 
action  of  the  two  parts  of  our  system  upon  each  other. 

I  hope  my  unknown  friend  will  excuse  the  length  and  freedom 
of  this  letter:  its  length  has  much  exceeded  my  intentions,  yet 
I  may  have  omitted  information  which  the  experience  of  the 
Retreat  might  afford,  and  which  would  have  been  useful  to 
promoters  of  the  New- York  Asylum.  Should  this  be  the  case, 
I  shall  be  glad  to  answer,  as  well  as  I  am  able,  any  questions 
which  they  may  propose;  and,  with  the  best  wishes  for  the 
success  of  their  benevolent  and  important  undertaking, 
I  remain,  respectfully, 

Thy  friend, 

SAMUEL  TUKE. 


[  199] 


APPENDIX    III 

THOMAS   EDDY'S   COMMUNICATION  TO  THE 
BOARD  OF   GOVERNORS,   APRIL,  1815  * 

Of  the  numerous  topics  of  discussion  on  subjects  relating  to 
the  cause  of  humanity,  there  is  none  which  has  stronger  claims 
to  our  attention,  than  that  which  relates  to  the  treatment  of  the 
insane. 

Though  we  may  reasonably  presume,  this  subject  was  by 
no  means  overlooked  by  the  ancients,  we  may  fairly  conclude, 
it  is  deservedly  the  boast  of  modern  times,  to  have  treated  it 
with  any  degree  of  success. 

It  would  have  been  an  undertaking  singularly  interesting 
and  instructive,  to  trace  the  different  methods  of  cure  which 
have  been  pursued  in  different  ages,  in  the  treatment  of  those 
labouring  under  mental  derangement:  and  to  mark  the  various 
results  with  which  they  were  attended.  The  radical  defect,  in 
all  the  different  modes  of  cure  that  have  been  pursued,  appears 
to  be,  that  of  considering  mania  a  •physical  or  bodily  disease, 
and  adopting  for  its  removal  merely  physical  remedies.  Very 
lately,  however,  a  spirit  of  inquiry  has  been  excited,  which  has 
given  birth  to  a  new  system  of  treatment  of  the  insane;  and 
former  modes  of  medical  discipline  have  now  given  place  to 
that  which  is  generally  denominated  moral  management. 

This  interesting  subject  has  closely  engaged  my  attention 
for  some  years,  and  I  conceive  that  the  further  investigation 
of  it  may  prove  highly  beneficial  to  the  cause  of  humanity,  as 
well  as  to  science,  and  excite  us  to  a  minute  inquiry,  how  far 
we  may  contribute  to  the  relief  and  comfort  of  the  maniacs 

*  "Hints  for  Introducing  an  Improved  Mode  of  Treating  the  Insane  in  the 
Asylum";  read  before  the  Governors  of  the  New  York  Hospital  on  the  4th  of 
Fourth-month,  1815.  By  Thomas  Eddy,  one  of  the  Asylum  Committee.  New 
York,  1815.  Reprinted  Bloomingdale  Hospital  Press,  1916. 

[  2OO  ] 


MORAL   TREATMENT   OF    INSANE 

placed  under  our  care.  In  pursuing  this  subject,  my  views  have 
been  much  extended,  and  my  mind  considerably  enlightened, 
by  perusing  the  writings  of  Doctors  Creighton,  Arnold,  and 
Rush;  but,  more  particularly,  the  account  of  the  Retreat  near 
York,  in  England.  Under  these  impressions  I  feel  extremely 
desirous  of  submitting  to  the  consideration  of  the  Governors, 
a  plan  to  be  adopted  by  them,  for  introducing  a  system  of  moral 
treatment  for  the  lunatics  in  the  Asylum,  to  a  greater  extent 
than  has  hitherto  been  in  use  in  this  country.  The  great  utility 
of  confining  ourselves  almost  exclusively  to  a  course  of  moral 
treatment,  is  plain  and  simple,  and  incalculably  interesting  to 
the  cause  of  humanity;  and  perhaps  no  work  contains  so  many 
excellent  and  appropriate  observations  on  the  subject,  as  that 
entitled,  The  Account  of  the  Retreat.  The  author,  Samuel  Tuke, 
was  an  active  manager  of  that  establishment,  and  appears  to 
have  detailed,  with  scrupulous  care  and  minuteness,  the  effects 
of  the  system  pursued  toward  the  patients.  I  have,  therefore, 
in  the  course  of  the  following  remarks,  with  a  view  of  illustrating 
the  subject  with  more  clearness,  often  adopted  the  language 
and  opinions  of  Tuke,  but  having  frequently  mixed  my  own  ob- 
servations with  his,  and  his  manner  of  expression  not  being 
always  adapted  to  our  circumstances  and  situation,  I  have 
attempted  to  vary  the  language,  so  as  to  apply  it  to  our  own 
institution;  this  will  account  for  many  of  the  subsequent  remarks 
not  being  noticed  as  taken  from  Tuke's  work. 

It  is,  in  the  first  place,  to  be  observed,  that  in  most  cases  of 
insanity,  from  whatever  cause  it  may  have  arisen,  or  to  what- 
ever extent  it  may  have  proceeded,  the  patient  possesses  some 
small  remains  of  ratiocination  and  self-command;  and  although 
many  cannot  be  made  sensible  of  the  irrationality  of  their  con- 
duct or  opinions,  yet  they  are  generally  aware  of  those  particu- 
lars for  which  the  world  considers  them  proper  objects  of  con- 
finement. Thus  it  frequently  happens,  that  a  patient,  on  his 
first  introduction  into  the  asylum,  will  conceal  all  marks  of 
mental  aberration;  and,  in  some  instances,  those  who  before 
have  been  ungovernable,  have  so  far  deceived  their  new  friends, 
as  to  make  them  doubt  their  being  insane. 

[201  ] 


APPENDIX    III 

It  is  a  generally  received  opinion,  that  the  insane  who  are 
violent,  may  be  reduced  to  more  calmness  and  quiet,  by  exciting 
the  principle  of  fear,  and  by  the  use  of  chains  or  corporal  pun- 
ishments. There  cannot  be  a  doubt  that  the  principle  of  fear 
in  the  human  mind,  when  moderately  and  judiciously  excited, 
as  it  is  by  the  operation  of  just  and  equal  laws,  has  a  salutary 
effect  on  Society.  It  is  of  great  use  in  the  education  of  children, 
whose  imperfect  knowledge  and  judgment,  occasion  them  to  be 
less  influenced  by  other  motives.  But  where  fear  is  too  much 
excited,  and  especially,  when  it  becomes  the  chief  motive  of 
action,  it  certainly  tends  to  contract  the  understanding,  weaken 
the  benevolent  affection,  and  to  debase  the  mind.  It  is,  there- 
fore, highly  desirable,  and  more  wise,  to  call  into  action,  as 
much  as  possible,  the  operation  of  superior  motives.  Fear 
ought  never  to  be  induced,  except  when  an  object  absolutely 
necessary  cannot  be  otherwise  obtained.  Maniacs  are  often 
extremely  irritable;  every  care,  therefore,  should  be  taken,  to 
avoid  that  kind  of  treatment  that  may  have  any  tendency 
towards  exciting  the  passions.  Persuasion  and  kind  treatment, 
will  most  generally  supersede  the  necessity  of  coercive  means. 
There  is  considerable  analogy  between  the  judicious  treatment 
of  children  and  that  of  insane  persons.  Locke  has  observed 
"the  great  secret  of  education  is  in  finding  out  the  way  to  keep 
the  Child's  Spirit  easy,  active  and  free;  and  yet,  at  the  same 
time,  to  restrain  him  from  many  things  he  has  a  mind  to,  and 
to  draw  him  to  things  which  are  uneasy  to  him."  Even  with 
the  more  violent  and  vociferous  maniacs,  it  will  be  found  best 
to  approach  them  with  mild  and  soft  persuasion.  Every  pains 
should  be  taken  to  excite  in  the  patient's  mind  a  desire  of  es- 
teem. Though  this  may  not  be  sufficiently  powerful  to  enable 
them  to  resist  the  strong  irregular  tendency  of  their  disease; 
yet,  when  -properly  cultivated,  it  may  lead  many  to  struggle  to 
overcome  and  conceal  their  morbid  propensities,  or  at  least, 
to  confine  their  deviations  within  such  bounds  as  do  not  make 
them  obnoxious  to  those  about  them.  This  struggle  is  highly 
beneficial  to  the  patient;  by  strengthening  his  mind,  and  con- 
ducing to  a  salutary  habit  of  self-restraint,  an  object,  no  doubt, 

[  2O2  ] 


MORAL   TREATMENT   OF    INSANE 

of  the  greatest  importance  to  the  care  of  insanity  by  moral 
means. 

It  frequently  occurs,  that  one  mark  of  insanity  is  a  fixed  false 
conception,  and  a  total  incapacity  of  reasoning.  In  such  cases, 
it  is  generally  advisable  to  avoid  reasoning*  with  them,  as  it 
irritates  and  rivets  their  false  perception  more  strongly  on  the 
mind.  On  this  account,  every  means  ought  to  be  taken  to  se- 
duce the  mind  from  unhappy  and  favourite  musings;  and  par- 
ticularly with  melancholic  patients;  they  should  freely  partake 
of  bodily  exercises,  walking,  riding,  conversations,  innocent 
sports,  and  a  variety  of  other  amusements;  they  should  be 
gratified  with  birds,  deer,  rabbits,  etc.  Of  all  the  modes  by 
which  maniacs  may  be  induced  to  restrain  themselves,  regular 
employment  is  perhaps  the  most  efficacious;  and  those  kind  of 
employments  are  to  be  preferred,  both  on  a  moral  and  physical 
account,  which  are  accompanied  by  considerable  bodily  action, 
most  agreeable  to  the  patient,  and  most  opposite  to  the  illusions 
of  his  disease. 

In  short  the  patient  should  be  always  treated  as  much  like  a 
rational  being  as  the  state  of  his  mind  will  possibly  allow.  In 
order  that  he  may  display  his  knowledge  to  the  best  advantage, 
such  topics  should  be  introduced  as  will  be  most  likely  to  interest 
him;  if  he  is  a  mechanic  or  an  agriculturalist,  he  should  be  asked 
questions  relating  to  his  art,  and  consulted  upon  any  occasion 
in  which  his  knowledge  may  be  useful.  These  considerations 

*  The  following  anecdotes  illustrate  the  observation  before  made,  that 
maniacs  frequently  retain  the  power  of  reasoning  to  a  certain  extent;  and  that 
the  discerning  physician  may  oftimes  successfully  avail  himself  of  the  remains 
of  this  faculty  in  controlling  the  aberrations  of  his  patient: — A  patient  in  the 
Pennsylvania  Hospital,  who  called  his  physician  his  father,  once  lifted  his 
hand  to  strike  him.  "What!"  said  his  physician,  (Dr.  Rush),  with  a  plaintive 
tone  of  voice,  "Strike  your  father?"  The  madman  dropped  his  arm,  and 
instantly  showed  marks  of  contrition  for  his  conduct.  The  following  was 
related  to  me  by  Samuel  Coates,  President  of  the  Pennsylvania  Hospital: — 
A  maniac  had  made  several  attempts  to  set  fire  to  the  Hospital:  upon  being 
remonstrated  with,  he  said,  "I  am  a  salamander;  "but  recollect,"  said  my  friend 
Coates,  "all  the  patients  in  the  house  are  not  salamanders;"  "That  is  true," 
said  the  maniac,  and  never  afterwards  attempted  to  set  fire  to  the  Hospital. 

[203  ] 


APPENDIX    III 

are  undoubtedly  very  material,  as  they  regard  the  comforts  of 
insane  persons;  but  they  are  of  far  greater  importance  as  they 
relate  to  the  cure  of  the  disorder.  The  patient,  feeling  himself 
of  some  consequence,  is  induced  to  support  it  by  the  exertion 
of  his  reason,  and  by  restraining  those  dispositions,  which,  if 
indulged,  would  lessen  the  respectful  treatment  he  wishes  to 
receive,  or  lower  his  character  in  the  eyes  of  his  companions 
and  attendants. 

Even  when  it  is  absolutely  necessary  to  employ  coercion,  if 
on  its  removal  the  patient  promises  to  control  himself,  great 
reliance  may  frequently  be  placed  upon  his  word,  and  under 
this  engagement,  he  will  be  apt  to  hold  a  successful  struggle 
with  the  violent  propensities  of  his  disorder.  Great  advantages 
may  also  be  derived,  in  the  moral  management  of  maniacs, 
from  an  acquaintance  with  the  previous  employment,  habits, 
manners,  and  prejudices  of  the  individual:  this  may  truly  be 
considered  as  indispensably  necessary  to  be  known,  as  far  as  can 
be  obtained;  and,  as  it  may  apply  to  each  case,  should  be 
registered  in  a  book  for  the  inspection  of  the  Committee  of  the 
Asylum,  and  the  physician;  the  requisite  information  should  be 
procured  immediately  on  the  admission  of  each  patient;  the 
mode  of  procuring  it  will  be  spoken  of  hereafter. 

Nor  must  we  forget  to  call  to  our  aid,  in  endeavouring  to 
promote  self-restraint,  the  mild  but  powerful  influence  of  the 
precepts  of  our  holy  religion.  Where  these  have  been  strongly 
imbued  in  early  life,  they  become  little  less  than  principles  of 
our  nature;  and  their  restraining  power  is  frequently  felt,  even 
under  the  delirious  excitement  of  insanity.  To  encourage  the 
influence  of  religious  principles  over  the  mind  of  the  insane, 
may  be  considered  of  great  consequence,  as  a  means  of  cure, 
provided  it  be  done  with  great  care  and  circumspection.  For 
this  purpose,  as  well  as  for  reasons  still  more  important,  it 
would  certainly  be  right  to  promote  in  the  patient,  as  far  as 
circumstances  would  permit,  an  attention  to  his  accustomed 
modes  of  paying  homage  to  his  Maker. 

In  pursuing  the  desirable  objects  above  enumerated,  we  ought 
not  to  expect  too  suddenly  to  reap  the  good  effects  of  our  en- 

[204] 


MORAL   TREATMENT   OF    INSANE 

deavours;  nor  should  we  too  readily  be  disheartened  by  occa- 
sional disappointments.  It  is  necessary  to  call  into  action, 
as  much  as  possible,  every  remaining  power  and  principle  of 
the  mind,  and  to  remember,  that,  "in  the  wreck  of  the  intellect, 
the  affections  very  frequently  survive."  Hence  the  necessity  of 
considering  the  degree  in  which  the  patient  may  be  influenced 
by  moral  and  rational  inducements. 

The  contradictory  features  in  their  characters,  frequently 
render  it  exceedingly  difficult  to  insure  the  proper  treatment  of 
insane  persons;  to  pursue  this  with  any  hopes  of  succeeding, 
so  that  we  may  in  any  degree  ameliorate  their  distressed  con- 
dition, renders  it  indispensably  necessary  that  attendants  only 
should  be  chosen  who  are  possessed  of  good  sense,  and  of  amiable 
dispositions,  clothed,  as  much  as  possible,  with  philosophical 
reflexion,  and  above  all,  with  that  love  and  charity  that  mark 
the  humble  Christian. 

Agreeably  to  these  principles,  I  beg  leave  to  suggest  the  fol- 
lowing regulations  to  be  adopted,  in  accomplishing  the  objects 
in  view. 

1st.     No  patient  shall  hereafter  be  confined  by  chains. 

2nd.  In  the  most  violent  states  of  mania,  the  patient  should 
be  confined  in  a  room  with  the  windows,  etc.,  closed,  so  as  nearly 
to  exclude  the  light,  and  kept  confined  if  necessary,  in  a  straight 
jacket,  so  as  to  walk  about  the  room  or  lie  down  on  the  bed  at 
pleasure;  or  by  strops,  etc.,  he  may,  particularly  if  there  ap- 
pears in  the  patient  a  strong  determination  to  self-destruction, 
be  confined  on  the  bed,  and  the  apparatus  so  fixed  as  to  allow 
him  to  turn  and  otherwise  change  his  positions. 

3rd.  The  power  of  judicious  kindness  to  be  generally  exer- 
cised, may  often  be  blessed  with  good  effects,  and  it  is  not  till 
after  other  moral  remedies  are  exercised,  that  recourse  should 
be  had  to  restraint,  or  the  power  of  fear  on  the  mind  of  the  pa- 
tient; yet  it  may  be  proper  sometimes,  by  way  of  punishment, 
to  use  the  shower  bath. 

4th.  The  common  attendants  shall  not  apply  any  extraordi- 
nary coercion  by  way  of  punishment,  or  change  in  any  degree 
the  mode  of  treatment  prescribed  by  the  physician;  on  the  con- 

[205] 


APPENDIX    III 

trary,  it  is  considered  as  their  indispensable  duty,  to  seek  by 
acts  of  kindness  the  good  opinion  of  the  patients,  so  as  to  gov- 
ern them  by  the  influence  of  esteem  rather  than  of  severity. 

5th.  On  the  first  day  of  the  week,  the  Superintendent,  or 
the  principal  keeper  of  the  Asylum,  shall  collect  as  many  of  the 
patients  as  may  appear  to  them  suitable,  and  read  some  chapters 
in  the  Bible. 

6th.  When  it  is  deemed  necessary  to  apply  the  strait-jacket, 
or  any  other  mode  of  coercion,  by  way  of  punishment  or  re- 
straint, such  an  ample  force  should  be  employed  as  will  preclude 
the  idea  of  resistance  from  entering  the  mind  of  the  patient. 

yth.  It  shall  be  the  duty  of  the  deputy-keeper,  immediately 
on  a  patient  being  admitted,  to  obtain  his  name,  age,  where 
born,  what  has  been  his  employment  or  occupation,  his  general 
disposition  and  habits,  when  first  attacked  with  mania;  if  it 
has  been  violent  or  otherwise,  the  cause  of  his  disease,  if  occa- 
sioned by  religious  melancholy,  or  a  fondness  for  ardent  spirits, 
if  owing  to  an  injury  received  on  any  part  of  the  body,  or  sup- 
posed to  arise  from  any  other  known  cause,  hereditary  or  ad- 
ventitious, and  the  name  of  the  physician  who  may  have  at- 
tended him,  and  his  manner  of  treating  the  patient  while  under 
his  direction. 

8th.  Such  of  the  patients  as  may  be  selected  by  the  physi- 
cian, or  the  Committee  of  the  Asylum,  shall  be  occasionally 
taken  out  to  walk  or  ride  under  the  care  of  the  deputy-keeper; 
and  it  shall  be  also  his  duty  to  employ  the  patients  in  such  man- 
ner, and  to  provide  them  with  such  kinds  of  amusements  and 
books  as  may  be  approved  and  directed  by  the  Committee. 

9th.  The  female  keeper  shall  endeavour  to  have  the  female 
patients  Constantly  employed  at  suitable  work;  to  provide 
proper  amusements,  books,  etc.,  to  take  them  out  to  walk  as 
may  be  directed  by  the  Committee. 

loth.  It  shall  be  the  indispensable  duty  of  the  keepers,  to 
have  all  the  patients  as  clean  as  possible  in  their  persons,  and 
to  preserve  great  order  and  decorum  when  they  sit  down  to 
their  respective  meals. 

nth.     It  shall  be  the  duty  of  the  physician  to  keep  a  book, 

[206] 


MORAL   TREATMENT   OF    INSANE 

in  which  shall  be  entered  an  historical  account  of  each  patient, 
stating  his  situation,  and  the  medical  and  moral  treatment 
used;  which  book  shall  be  laid  before  the  Committee,  at  their 
weekly  meetings. 

The  sentiments  and  improvements  proposed  in  the  preceding 
remarks,  for  the  consideration  of  the  Governors,  are  adapted 
to  our  present  situation  and  circumstances;  but  a  further  and 
more  extensive  improvement  has  occurred  to  my  mind,  which 
I  conceive,  would  very  considerably  conduce  towards  affecting 
the  cure,  and  materially  ameliorate  the  condition,  and  add 
to  the  comfort  of  the  insane;  at  the  same  time  that  it  would 
afford  an  ample  apportunity  of  ascertaining  how  far  that  disease 
may  be  removed  by  moral  management  alone,  which  it  is  be- 
lieved, will,  in  many  instances,  be  more  effectual  in  controlling 
the  maniac,  than  medical  treatment  especially,  in  those  cases 
where  the  disease  has  proceeded  from  causes  operating  directly 
on  the  mind. 

I  would  propose,  that  a  lot,  not  less  than  ten  acres,  should 
be  purchased  by  the  Governors,  conveniently  situated,  within 
a  few  miles  of  the  city,  and  to  erect  a  substantial  building,  on  a 
plan  calculated  for  the  accommodation  of  fifty  lunatic  patients; 
the  ground  to  be  improved  in  such  a  manner  as  to  serve  for 
agreeable  walks,  gardens,  etc.,  for  the  exercise  and  amusement 
of  the  patients:  this  establishment  might  be  placed  under  the 
care  and  superintendence  of  the  Asylum  Committee,  and  be 
visited  by  them  once  every  week:  a  particular  description  of 
patients  to  remain  at  this  Rural  Retreat;  and  such  others  as 
might  appear  suitable  objects  might  be  occasionally  removed 
there  from  the  Asylum. 

The  cost  and  annual  expense  of  supporting  this  establishment, 
are  matters  of  small  consideration,  when  we  duly  consider  the 
important  advantages  it  would  offer  to  a  portion  of  our  fellow- 
creatures,  who  have  such  strong  claims  on  our  sympathy  and 
commiseration. 

But,  it  is  a  fact  that  can  be  satisfactorily  demonstrated,  that 
such  an  establishment  would  not  increase  our  expenses;  and, 
moreover,  would  repay  us  even  the  interest  of  the  money  that 

[207] 


APPENDIX    III 

might  be  necessary  to  be  advanced,  for  the  purchase  of  the 
ground  and  erecting  the  buildings.  The  board  of  patients  (sup- 
posing fifty)  would  yield  two  hundred  dollars  per  week,  or  ten 
thousand  four  hundred  dollars  per  annum. 

Supposing  the  ground,  building,  etc.,  to  cost  $50,000,  the 
interest  on  this  sum  at  6  per  cent,  would  be  $3,000,  there  would 
yet  remain  $7,400,  for  the  maintenance  and  support  of  the  es- 
tablishment; a  sum  larger  than  would  be  required  for  that 
purpose. 

We  had  lately  in  the  Asylum,  more  than  ninety  patients; 
and,  at  that  time,  had  repeated  applications  to  receive  an  ad- 
ditional number;  the  Committee  however,  concluded,  that  as 
the  building  was  not  calculated  to  accommodate  more  than 
seventy-five,  it  would  be  an  act  of  injustice  to  take  in  any  more; 
they,  therefore,  concluded  to  reduce  the  number  of  seventy- 
five,  and  strictly  to  refuse  receiving  any  beyond  that  number. 
This  may  serve  clearly  to  show,  that  we  might  safely  calculate, 
that  we  should  readily  have  applications  to  accommodate  one 
hundred  and  twenty-five  patients. 

This  succinct  view  of  the  subject  may  suffice,  at  this  time,  as 
outlines  of  my  plan;  and  which  is  respectfully  submitted  to  the 
Governors,  for  their  Consideration. 


[208] 


APPENDIX   IV 

EXTRACTS   FROM  THE  MINUTES  OF  THE  BOARD 
OF   GOVERNORS   IN   RELATION  TO  ACTION 
TAKEN  RESPECTING  THOS.  EDDY'S  COM- 
MUNICATION  DATED  APRIL,   1815 

April  4,  1815. 

A  communication  was  received  from  Thos.  Eddy  suggesting 
several  improvements  in  the  mode  of  treating  Insane  persons, 
which  is  referred  to  Dr.  Hugh  Williamson,  George  Newbold, 
William  Johnson,  Peter  A.  Jay,  and  John  R.  Murray — Resolved 
that  the  Treasurer  have  fifty  copies  of  the  report  printed  for  use 
of  the  Governors. 

July  3,  1815. 

The  Committee  on  the  communication  from  Thos.  Eddy, 
relative  to  the  treatment  of  Insane  patients,  report  attention  to 
the  subject  and  that  in  their  opinion  it  is  advisable  to  have  a  few 
acres  of  land  purchased  in  the  vicinity  of  the  City  for  the  better 
accommodation  of  this  unhappy  class  of  our  fellow  creatures — 
the  Committee  are  continued. 

On  motion  Resolved  that  Thomas  Eddy,  John  A.  Murray, 
and  John  Aspinwall,  be  a  Committee  to  look  out  for  a  suitable 
spot  of  land,  and  to  make  a  purchase,  if  in  their  opinion  it  shall 
become  necessary. 

8th  Month  (August)  ist,  1815. 

The  Committee  on  the  communication  from  Thomas  Eddy, 
made  the  following  Report,  which  was  intended  to  have  been 
laid  before  the  last  meeting  of  the  Board;  which  was  now  ac- 
cepted, and  ordered  to  be  inserted  in  the  minutes. 

[209] 


APPENDIX    IV 

"The  Committee  appointed  to  consider  the  expediency  of 
erecting  another  Building  for  the  accommodation  of  Insane 
Persons  Report: 

That  another  building  for  the  use  of  those  unfortunate  per- 
sons who  have  lost  the  use  of  their  reason,  is  not  only  advisable, 
but  seems  to  be  absolutely  necessary. 

That  though  there  are  at  present  more  patients  in  the  Asy- 
lum, by  nearly  one  third,  than  can  with  perfect  Safety,  and  the 
best  hopes  of  recovery,  be  lodged  there;  many  more  insane 
persons,  perhaps  twenty  within  a  few  months,  have  by  their 
friends  been  soliciting  a  place  in  that  Building — In  speaking  of 
the  want  of  safety,  the  Committee  only  mean  to  express  an 
opinion,  that  when  two  or  more  insane  persons,  from  the  want 
of  room  are  lodged  together  in  one  cell,  the  life  of  the  weaker 
must  be  somewhat  endangered  by  the  stronger,  who  in  a  high 
Paroxysm  of  insanity  might  strangle  him  in  his  sleep,  or  other- 
wise destroy  him. 

That  such  additional  Building,  from  the  want  of  room,  can- 
not possibly  be  erected  near  the  hospital,  in  this  city. 

That  there  are  many  reasons  for  believing  that  the  recovery 
from  a  state  of  insanity  would  be  greatly  promoted,  by  having 
a  considerable  space  of  ground  adjoining  the  Asylum  or  Public 
Building,  in  which  many  of  the  patients  might  have  the  privi- 
lege of  walking,  or  taking  other  kinds  of  exercise. 

That  considering  the  various  kinds  of  insanity,  your  Com- 
mittee, are  clearly  of  the  opinion,  that  two  buildings  should  be 
erected  at  the  distance  of  at  least  one  hundred  yards  from  each 
other.  The  sedate  or  melancholy  madman  should  not  have  his 
slumbers  broken  by  living  under  the  same  roof  with  disorderly 
persons,  who  by  singing,  or  other  noisy  proceedings,  will  not 
suffer  their  neighbours  to  sleep. 

[210] 


PURCHASE   OF    FIRST    SITE 

That  for  the  above  and  similar  considerations,  it  would  be 
advisable,  to  purchase,  within  a  few  miles  of  this  City,  at  least 
twenty  acres  of  land,  detached  from  private  buildings,  in  a 
healthy  and  pleasant  situation,  where  the  water  is  good  and 
where  materials  for  buildings  may  be  obtained  on  easy  terms: 
and  the  portage  of  fuel  not  expensive. 

Your  Committee  are  aware  that  a  smaller  lot  of  ground 
might  suffice  for  all  the  buildings  that  are  now  required,  or  all 
this  Corporation  may,  in  a  short  time,  be  enabled  to  complete. 
But  they  count  it  advisable  to  prepare  for  a  period  that  must 
certainly  come;  a  period  in  which  such  a  lot  will  be  needed, 
and  not  easily  obtained,  for  it  is  evident  from  the  topography, 
and  geographical  position  of  this  City,  that  the  time  must 
come,  when  New  York  will  be  not  only  the  greatest  City  in  the 
United  States,  or  in  America;  but  must  rival  the  most  distin- 
guished City's  in  the  old  Continent. 

Wherefore  it  is  recommended,  that  a  Committee  be  ap- 
pointed, who  shall  examine  the  sundry  places,  corresponding 
with  the  above  description,  that  may  be  purchased.  And  that 
they  report  the  means  of  making  the  purchase,  and  of  erecting 
such  Buildings,  as  seem  at  this  time  to  be  required." 

The  Committee  to  whom  was  referred,  to  purchase  a  suita- 
ble Lot  of  Land  for  the  erection  of  a  House  for  the  accommoda- 
tion of  maniacs,  Report  that  they  have  purchased  38  acres  of 
Land,  being  part  of  the  Estate  belonging  to  Gerard  Depeyster 
at  Bloomingdale,  at  the  rate  of  $246.  per  acre,  payable  25  per 
cent  down,  37^  per  cent  on  ist  November  and  37^  per  cent 
on  ist  February  next,  with  interest. 

THOMAS  EDDY,  Chairman 

August  ist,  1815 

Whereupon  Resolved  that  the  Report  of  the  Committee  be 
accepted,  and  they  are  instructed  to  take  the  Titles,  after  P.  A. 
Jay  shall  have  examined  the  Records,  and  be  satisfied  that  the 
property  is  free  of  incumbrance. 

[211] 


APPENDIX    V 

ADDRESS  TO  THE  PUBLIC  BY  THE  GOVERNORS 

1821* 

The  Governors  of  the  New- York  Hospital  have  the  satis- 
faction to  announce  to  the  public,  the  completion  of  the  Asy- 
lum for  the  insane;  and  that  it  will  be  open  for  the  reception  of 
patients,  from  any  part  of  the  United  States,  on  the  first  day 
of  June. 

This  Asylum  is  situated  on  the  Bloomingdale  road,  about 
seven  miles  from  the  City  Hall  of  the  city  of  New-York,  and 
about  three  hundred  yards  from  the  Hudson  River.  The 
building  is  of  hewn  free-stone,  211  feet  in  length,  and  sixty- 
feet  deep,  and  is  calculated  for  the  accommodation  of  about 
two  hundred  patients.  Its  scite  is  elevated,  commanding  an 
extensive  and  delightful  view  of  the  Hudson,  the  East  River, 
and  the  Bay  and  Harbour  of  New-York,  and  the  adjacent 
country,  and  is  one  of  the  most  beautiful  and  healthy  spots  on 
New- York  Island.  Attached  to  the  building  are  about  seventy 
acres  of  land,  a  great  part  of  which  has  been  laid  out  in  walks, 
ornamental  grounds,  and  extensive  gardens. 

This  institution  has  been  established  by  the  bounty  of  the 
Legislature  of  the  state  of  New- York,  on  the  most  liberal  and 
enlarged  plan,  and  with  the  express  design  to  carry  into  effect 
that  system  of  management  of  the  insane,  happily  termed 
moral  treatment,  the  superior  efficacy  of  which  has  been  demon- 
strated in  several  of  the  Hospitals  of  Europe,  and  especially 
in  that  admirable  establishment  of  the  Society  of  Friends, 
called  "THE  RETREAT,"  near  York,  in  England.  This  mild 
and  humane  mode  of  treatment,  when  contrasted  with  the 

*  Address  of  the  Governors  of  the  New  York  Hospital  to  the  Public,  Relative 
to  the  Asylum  for  the  Insane  at  Bloomingdale.  New  York,  May  10th,  1821. 
Reprinted  Bloomingdale  Hospital  Press,  May  1921. 

[212] 


ADDRESS   TO   THE    PUBLIC,    1821 

harsh  and  cruel  usage,  and  the  severe  and  unnecessary  restraint, 
which  have  formerly  disgraced  even  the  most  celebrated  lunatic 
asylums,  may  be  considered  as  one  of  the  noblest  triumphs  of 
pure  and  enlightened  benevolence.  But  it  is  by  no  means  the 
intention  of  the  governors  to  rely  on  moral,  to  the  exclusion 
of  medical  treatment.  It  is  from  a  judicious  combination  of 
both,  that  the  greatest  success  is  to  be  expected  in  every  at- 
tempt to  cure  or  mitigate  the  disease  of  insanity. 

In  the  construction  of  the  edifice  and  in  its  interior  arrange- 
ments, it  has  been  considered  important  to  avoid,  as  far  as 
practicable,  consistently  with  a  due  regard  to  the  safety  of  the 
patients,  whatever  might  impress  their  minds  with  the  idea  of 
a  prison,  or  a  place  of  punishment,  and  to  make  every  thing 
conduce  to  their  health  and  to  their  ease  and  comfort.  The 
self-respect  and  complacency  which  may  thus  be  produced  in 
the  insane,  must  have  a  salutary  influence  in  restoring  the  mind 
to  its  wonted  serenity.  In  the  disposition  of  the  grounds 
attached  to  the  Asylum,  everything  has  been  done  with  refer- 
ence to  the  amusement,  agreeable  occupation,  and  salutary 
exercise  of  the  patients. 

Agricultural,  horticultural,  and  mechanical  employments, 
may  be  resorted  to,  whenever  the  inclination  of  the  patient,  or 
their  probable  beneficial  effects  may  render  them  desirable. 
To  dispel  gloomy  images,  to  break  morbid  associations,  to  lead 
the  feelings  into  their  proper  current,  and  to  restore  the  mind 
to  its  natural  poise,  varius  less  active  amusements  will  be  pro- 
vided. Reading,  writing,  drawing,  innocent  sports,  tending 
and  feeding  domestic  animals,  &c.  will  be  encouraged  as  they 
may  be  found  conducive  to  the  recovery  of  the  patients.  A 
large  garden  has  been  laid  out,  orchards  have  been  planted,  and 
yards,  containing  more  than  two  acres,  have  been  inclosed  for 
the  daily  walks  of  those  whose  disorder  will  not  allow  more 
extended  indulgence.  The  plants  of  the  Elgin  Botanic  garden, 
presented  to  this  institution  by  the  Trustees  of  Columbia  Col- 
lege, have  been  arranged  in  a  handsome  green-house,  prepared 
for  their  reception. 

The  apartments  of  the  house  are  adapted  to  the  accommoda- 

[213  ] 


APPENDIX   V 

tion  of  the  patients,  according  to  their  sex,  degree  of  disease, 
habits  of  life,  and  the  wishes  of  their  friends.  The  male  and 
female  apartments  are  entirely  separated,  so  as  to  be  completely 
secluded  from  the  view  of  each  other. 

Care  has  been  taken  to  appoint  a  Superintendent  and  Matron, 
of  good  moral  and  religious  characters,  possessing  cheerful 
tempers,  and  kind  dispositions,  united  with  firmness,  vigilance 
and  discretion.  A  Physician  will  reside  in  the  house,  and  one  or 
more  Physicians,  of  established  character  and  experience,  will 
attend  regularly,  and  afford  medical  aid  in  all  cases  where  the 
general  health,  or  the  particular  cause  of  the  patient's  insanity, 
may  require  it.  The  relations  or  friends  of  patients  will  be  at 
liberty,  if  they  prefer  it,  to  employ  their  own  physicians,  who 
will  be  allowed  to  attend  patients,  subject  to  the  general  regula- 
tions of  the  house. 

The  institution  will  be  regularly  visited  and  inspected  by  a 
committee  of  the  Governors  of  the  Hospital,  who  will,  as  often 
as  they  may  think  it  advantageous,  be  attended  by  some  of  the 
physicians  of  the  city  of  high  character  and  respectability. 

The  charges  for  board  and  the  other  advantages  of  the  insti- 
tution, will  be  moderate,  and  proportioned  to  the  different  cir- 
cumstances of  the  patients,  and  the  extent  of  the  accommoda- 
tions desired  for  them. 

Patients  at  the  expense  of  the  different  towns  of  the  state,  will 
be  received  at  the  lowest  rate. 

Application  for  the  admission  of  patients  into  the  Asylum, 
must  be  made,  at  the  New  York  Hospital,  in  Broadway,  where 
temporary  accommodation  will  be  provided  for  such  patients 
as  may  require  it,  previously  to  their  being  carried  to  the  Asy- 
lum out  of  town.  A  committee  of  the  Governors  will,  when 
necessary,  attend  at  the  Hospital  in  Broadway,  for  the  purpose 
of  admitting  patients  into  the  Asylum,  and  to  agree  on  the  terms 
and  security  for  payment  to  be  given. 

By  order  of  the  board  of  Governors. 

MATTHEW  CLARKSON,  President. 
THOMAS  BUCKLEY,  Secretary. 

New-York,  loth  May,  1821. 

[214] 


ADDRESS    TO   THE    PUBLIC,    1821 

N.  B.  The  friends  of  the  patients  are  requested  to  send  with 
them  an  account  of  their  cases,  stating  the  probable  causes  of 
their  insanity,  the  commencement  and  peculiar  character  of  the 
disorder.  It  is  desirable  that  this  statement,  where  it  is  practi- 
cable, should  be  drawn  up  by  a  physician. 

Applications  from  abroad,  for  information  relative  to  the  ad- 
mission of  patients,  may  be  made  by  letters  addressed  to 
THOMAS  BUCKLEY,  Secretary  of  the  New- York  Hospital. 


APPENDIX    VI 


BOARD  OF  GOVERNORS  OF  THE 
SOCIETY  OF  THE  NEW  YORK   HOSPITAL 

l82I  AND   1921 


1821 


Matthew  Clarkson,  President 

Thomas  Eddy,  Vice  President 

Thomas  Franklin 

Jonathan  Little 

Thomas  Buckley 

William  Johnson 

Andrew  Morris 

John  R.  Murray 

John  B.  Lawrence 

George  Newbold 

Ebenezer  Stevens 

Peter  A.  Jay 

Najah  Taylor 


William 


Cadwallader  D.  Golden 
Robert  H.  Bowne 
Robert  I.  Murray 
Thomas  C.  Taylor 
John  Adams,  Treasurer 
John  McComb 

Benjamin  W.   Rogers,  Assis- 
tant Treasurer 
William  Bayard 
Nathan  Comstock 
Duncan  P.  Campbell 
Rev.  F.  C.  Schaeffer 
John  Clark,  Jr. 
Edgar,  Jr. 


1921 


Hermann  H.  Cammann 

Henry  W.  deForest 

Richard  Trimble 

Howard  Townsend 

George  F.  Baker 

Augustine  J.  Smith 

Charles  S.  Brown 

Edward  W.  Sheldon,  President 

Bronson  Winthrop 

Frank  K.  Sturgis 

David  B.  Ogden 

Joseph  H.  Choate,  Jr. 


Henry  G.  Barbey 
Cornelius  B.  Bliss,  Jr. 
Paul  Tuckerman,  Treasurer 
William  Woodward 
Arthur  Iselin 

Payne   Whitney,   Vice   Presi- 
dent 

G.  Beekman  Hoppin 
Lewis  Cass  Ledyard,  Jr. 
Henry  R.  Taylor 
R.  Horace  Gallatin 
Walter  Jennings 


[216] 


BOARD    OF    GOVERNORS 


BLOOMINGDALE    COMMITTEE 
1821 

Thomas  Eddy  John  Adams 

Cadwallader  D.  Golden  Thomas  Buckley 

Thomas  C.  Taylor  John  B.  Lawrence 


1921 

Frank  K.  Sturgis  Henry  G.  Barbey 

Augustine  J.  Smith  Walter  Jennings 

Henry  R.  Taylor  Howard  Townsend 


[217] 


APPENDIX   VII 

ORGANIZATION  OF   BLOOMINGDALE   HOSPITAL 

1821  AND   1921 

1821 

Superintendent  or  Warden I 

Housekeeper I 

Keepers,  Men 3 

Keepers,  Women 2 

Chambermaids I 

Cooks 3 

Baker i 

Assistant  Baker i 

Dairymaid I 

Washerwoman I 

Assistant  washerwoman i 

Yard  Keeper i 

Waitresses 2 

Gardener I 

Farmer I 

Assistant  farmer  I 


Total 22 

Number  of  patients 75 


[218] 


ORGANIZATION   OF    HOSPITAL 
1921 

Officers  and  employees:  Patients: 

Men 217  Men 132 

Women 195  Women 156 

Total 412  Total 288 

General  Administration  : 

Medical  Superintendent I 

Steward I — 2 

Clinical  and  Laboratory  Service  : 
Physicians : 

Resident 9 

Consultants 3 

Dentist I 

Assistant i 

Apothecary i 

Technicians 2 

Stenographers 5 — 22 

Nursing  Service : 

Director,  Assistant,  and  Instructor 3 

Nurses,  attendants,  and  pupils 135 

Maids  and  porters 46 — 184 

Occupational  Therapy 13 

Physical  Training 7 

Hydr other apy  and  Massage 5 

Dietary  Department 25 

Housekeeping  and  Laundry  Departments 60 

Financial,  Purchasing,  and  Supplies 10 

Engineering  Department 1 8 

Building  Department 20 

Industrial  Department 5 

Farm  and  Grounds 38 

Miscellaneous 8 

Chaplain,    Librarian,    Watchmen,    Telephonists, 
Postal  Clerk,  Barber. 

[219] 


ORGANIZATION   OF   HOSPITAL 


STATISTICS:  1821-1921 

Number  of  cases  admitted  1821  to  1921 13,41 1 

Number  discharged  recovered  1821  to  1921       ....  4,651 

Number  discharged  improved  1821  to  1921       ....  3,873 


[  220  ] 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 

Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


MAf30 


O 

CD 


Form  L9-40m-5,'67(H2161s8)4939 


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m 


111 


'££. 


